Payment for Dialysis Services in the Individual Market

Trish, Erin; Fiedler, Matthew; Ning, Ning; Gascue, Laura; Adler, Loren; Lin, Eugene

doi:10.1001/jamainternmed.2020.7372

Cited by 15 publications

(23 citation statements)

References 4 publications

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“…Additionally, alcohol screening procedures could be directly applied in counselling centers or at primary health care services [ 55 ] to identify individuals at risk extensively and as early as possible to refer them to prevention programs or brief interventions. Alcohol control policies such as the SAFER project or minimum-unit pricing [ 67 , 68 , 69 , 70 ] and efforts to reduce global unemployment [ 71 , 72 , 73 ] further pose well-suited initiatives.…”

Section: Discussionmentioning

confidence: 99%

Employment Status and Alcohol-Attributable Mortality Risk—A Systematic Review and Meta-Analysis

Saul

Lange

Probst

2022

IJERPH

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Being unemployed has been linked to various health burdens. In particular, there appears to be an association between unemployment and alcohol-attributable deaths. However, risk estimates presented in a previous review were based on only two studies. Thus, we estimated updated sex-stratified alcohol-attributable mortality risks for unemployed compared with employed individuals. A systematic literature search was conducted in August 2020 using the following databases: Embase, MEDLINE, PsycINFO, and Web of Science. The relative risk (RR) of dying from an alcohol-attributable cause of death for unemployed compared with employed individuals was summarized using sex-stratified random-effects DerSimonian-Laird meta-analyses. A total of 10 studies were identified, comprising about 14.4 million women and 19.0 million men, among whom there were about 3147 and 17,815 alcohol-attributable deaths, respectively. The pooled RRs were 3.64 (95% confidence interval (CI): 2.04–6.66) and 4.93 (95% CI 3.45–7.05) for women and men, respectively. The findings of our quantitative synthesis provide evidence that being unemployed is associated with an over three-fold higher risk of alcohol-attributable mortality compared with being employed. Consequently, a global public health strategy connecting brief interventions and specialized care with social services assisting those currently unemployed is needed.

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Section: Discussionmentioning

confidence: 99%

Employment Status and Alcohol-Attributable Mortality Risk—A Systematic Review and Meta-Analysis

Saul

Lange

Probst

2022

IJERPH

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“…This is even higher for non-Medicare spending, which is often greater by three-fold. 11 For every 2 patients on a standard thrice weekly schedule, 3 incremental patients on twice weekly dialysis could use the same chair in any given week ( Figure 2 ). According to a study by Obi et al, 45 if incremental hemodialysis regimens could be used for the first several months of therapy while patients still have sufficient RKF, $250 million to $500 million could be saved every year based on Medicare spending alone.…”

Section: The Economic Impact Of Incremental Dialysismentioning

confidence: 99%

Incremental Hemodialysis: What We Know so Far

Soi¹,

Faber²,

Paul³

2022

IJNRD

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Traditionally, patients that develop progressive chronic kidney disease in need of kidney replacement therapy are prescribed thrice weekly in-center hemodialysis sessions at the beginning of therapy. This empiric prescription is based on historic trials that were comprised of mostly prevalent patients. Incremental hemodialysis is the process of performing <3 sessions of dialysis per week or limiting dialysis dose by duration at the initial onset of treatment to provide a more gradual transition, mimicking the progressive nature of kidney disease. Adding clearance contributions from residual kidney function is the standard of care with peritoneal dialysis but has not routinely been employed with hemodialysis. Accounting for residual kidney function accompanied by improvement in adjuvant pharmacotherapy, such as newer potassium binding agents and dietary modification, can augment dialytic clearances and allow for an incremental approach. Utilizing incremental dialysis has been associated with both preserving residual kidney function as well as improving patient quality of life. Barriers to this approach include concerns regarding patient acceptance of dialysis prescription changes, adherence to therapy, and provider factors that would require a restructuring of the current thrice weekly hemodialysis rubric. Candidacy for incremental therapy has shown the best outcomes when urea clearances exceed 3 mL/min and urine volumes are >500 mL/day, although these measures have been deemed conservative. A significant amount of retrospective and registry data has been supportive of initiating incremental hemodialysis and several pilot studies have shown the feasibility of implementing such an approach. Larger, randomized control trials are needed to fully evaluate safety and efficacy to allow for more widespread acceptance of this patient-centered approach to chronic kidney disease.

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“…5 Studies in dialysis have linked acquisitions to decreased quality of care and worse health outcomes, 7,8 and growth in large dialysis organizations may lead to higher prices paid by private insurers. 9 The finding that dialysis facility acquisitions increased in association with a national dialysis reimbursement reform highlights the need for policymakers to consider how dialysis payment policies influence market competition. Looking forward, it will be important to understand how new payment models arising from the recently enacted Advancing American Kidney Health Initiative influence the structure of dialysis markets.…”

Section: + Related Articlementioning

confidence: 99%