Medicare Dialysis Payments Could Effect Home Dialysis Use

Medicare’s tiered fee-for-service reimbursement for dialysis lead to a reduction in the use of home dialysis, a recent study found.

In-home dialysis, including peritoneal dialysis and hemodialysis, can offer flexibility compared with in-center hemodialysis, according to the study published in the American Journal of Managed Care.

Researchers included patients who started dialysis 3 years prior to, and 3 years after, payment reform was enacted. Patients covered by both traditional Medicare and Medicare Advantage were included.

After the reform, patients with traditional Medicare had a 0.7% reduction in home dialysis compared with Medicare Advantage patients. Patients located near large dialysis facilities had a 0.9% reduction in home dialysis compared with patients located near smaller facilities.

In smaller centers, in-center hemodialysis is less profitable compared with larger facilities, according to the study. The larger centers are likely to gain a larger profit from in-center dialysis.

"We found that national physician payment reform enacted by Centers for Medicare and Medicaid Services in 2004 in an effort to encourage more frequent face-to-face dialysis visits and improve the quality of care resulted in an unintended consequence of relatively fewer patients choosing home dialysis," the authors concluded. "The tiered fee-for-service payment system enacted in 2004 continues to govern physician reimbursement for in-center hemodialysis care and, consequently, may continue to discourage home dialysis use in certain patient populations. These findings highlight both an area of policy failure and the importance of considering unintended consequences of future efforts to reform physician payment."