The Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor: Rationale and Methods for an Initiative to Monitor the New US Bundled Dialysis Payment System

Robinson, Bruce M.; Fuller, Douglas S.; Zinsser, Dawn; Albert, Justin M.; Gillespie, Brenda W.; Tentori, Francesca; Turenne, Marc N.; Port, Friedrich K.; Pisoni, Ronald L.

doi:10.1053/j.ajkd.2011.03.001

Cited by 50 publications

(35 citation statements)

References 15 publications

(15 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sampling design and analytic methods have been published, 41 and the DPM results have been consistent with published national data. 37,38,42 This study extends the DPM framework to other DOPPS countries with complete follow-up during the analysis period (Germany, Italy, Spain, the United Kingdom, and Japan) to describe and contrast regional trends in anemia practices and outcomes be- Treatment practices included prescription of ESA or iv iron during the prior 3 months and prescribed ESA dose.…”

Section: Data Sourcessupporting

confidence: 66%

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

Fuller

Bieber

Pisoni

et al. 2015

JASN

View full text Add to dashboard Cite

For years, erythropoiesis-stimulating agent (ESA) use among patients on dialysis was much higher in the United States than in Europe or Japan. Sweeping changes to dialysis reimbursement and regulatory policies for ESA in the United States in 2011 were expected to reduce ESA use and hemoglobin levels. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS) data from 7129 patients in 223 in-center hemodialysis facilities (average per month) to estimate and compare time trends in ESA dose and hemoglobin levels among patients on hemodialysis in the United States, Germany, Italy, Spain, the United Kingdom, and Japan. From 2010 to 2013, substantial declines in ESA use and hemoglobin levels occurred in the United States but not in other DOPPS countries. Between August of 2010 and April of 2013, mean weekly ESA dose in the United States decreased 40.4% for black patients and 38.0% for nonblack patients; mean hemoglobin decreased from 11.5 g/dl in black patients and 11.4 g/dl in nonblack patients to 10.6 g/dl in both groups. In 2010 and 2013, adjusted weekly ESA doses per kilogram were 41% and 11% lower, respectively, in patients in Europe and 60% and 18% lower, respectively, in patients in Japan than in nonblack patients in the United States. Adjusted hemoglobin levels in 2010 and 2013 were 0.07 g/dl lower and 0.56 g/dl higher, respectively, in patients in Europe and 0.93 and 0.01 g/dl lower, respectively, in patients in Japan than in nonblack patients in the United States. In conclusion, ESA dosing reductions in the United States likely reflect efforts in response to changes in reimbursement policy and regulatory guidance. 27: 220527: -221527: , 201627: . doi: 10.1681 Deficient renal erythropoietin production is a major factor contributing to the anemic status that affects the vast majority of patients on dialysis. 1 Treatment with erythropoiesis-stimulating agents (ESAs) and intravenous (iv) iron has been the cornerstone of anemia management for over two decades. 9 on the matter, data from the US Renal Data System were shared that indicated that more than one half of United States patients on dialysis had Hb levels above the US Food and Drug Administration 10 (FDA) target range of 10-12 g/dl, and the US Government Accounting Office 11 (GAO) presented a 2006 report recommending implementation of an expanded bundled payment for dialysis services including renal medications and laboratory services. Subsequent regulatory action culminated in three important changes that occurred in 2011. In January of 2011, the US Centers for Medicare and Medicaid Services (CMS) introduced a major modification to the ESRD Prospective Payment System (PPS) that was fully implemented nearly 90% of United States dialysis units, with the remainder opting to phase in over 4 years. The revised PPS added approximately $3 billion worth of separately billable services to the bundled payment, of which dose-based reimbursement for ESAs and iv iron accounted for approximately 67% and 8%, respectively. 12 In June of 2011, the FD...

show abstract

Section: Data Sourcessupporting

confidence: 66%

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

Fuller

Bieber

Pisoni

et al. 2015

JASN

View full text Add to dashboard Cite

show abstract

“…dopps.org/dpm). 8,28,29 The present analysis examines monthly cross-sectional data from August 2010 through December 2011. Anemia management measures in this analysis included Hgb (g/dl), ESA use (epoetin alfa or darbepoetin alfa, IV or subcutaneous administration), IVepoetin alfa dose (EPO; U/wk), IV iron use and dose (mg/mo), serum ferritin (ng/ml) levels, and transferrin saturation.…”

Section: Data Sourcementioning

confidence: 99%

Has Dialysis Payment Reform Led to Initial Racial Disparities in Anemia and Mineral Metabolism Management?

Turenne

Cope

Porenta

et al. 2015

Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

Implementation of the Medicare ESRD prospective payment system (PPS) and changes to dosing guidelines for erythropoiesis-stimulating agents (ESAs) in 2011 appear to have influenced use of injectable medications among dialysis patients. Given historically higher ESA and vitamin D use among black patients, we assessed the effect of these policy changes on racial disparities in the management of anemia and mineral metabolism. Analyses used cross-sectional monthly cohorts for a period-prevalent sample of 7384 maintenance hemodialysis patients at 132 facilities from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor. Linear splines with knots at each policy change were used in surveyweighted regressions to estimate time trends in hemoglobin (Hgb), erythropoietin (EPO) dose, intravenous (IV) iron dose, ferritin, transferrin saturation (TSAT) concentration, parathyroid hormone (PTH), IV vitamin D dose, cinacalcet use, and phosphate binder use. From August 2010 to December 2011, mean Hgb declined from 11.5 to 11.0 g/dl (P,0.001), mean EPO dose declined from 20,506 to 14,777 U/wk (P,0.001), and mean serum PTH increased from 340 to 435 pg/ml (P,0.001). No meaningful differences by race were observed regarding the rates of change of management practices or laboratory measures (all P.0.21). Mean EPO and vitamin D dose and serum PTH levels remained higher in blacks. Despite evidence that anemia and mineral metabolism management practices have changed significantly over time, there was no immediate indication of racial disparities resulting from implementation of the PPS or ESA label change. Further studies are needed to examine effects among patient and facility subgroups.

show abstract

“…This delay in data collection limits the ability to compare treatment changes before and after the implementation of the expanded bundle. The other system, the Dialysis Outcomes and Practice Patterns Monitor, samples 3% of the approximately 4700 US dialysis facilities to monitor effects of the expanded bundle on practice patterns (17). Although the practice monitor may be limited by sample size and further affected by industry consolidation, it has the advantage of comparing prebundle and postbundle practices.…”

Section: Monitoring the Effects Of Policy Changesmentioning

confidence: 99%

Comparing Mandated Health Care Reforms

Watnick

Weiner

Shaffer

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryIn addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

show abstract

The Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor: Rationale and Methods for an Initiative to Monitor the New US Bundled Dialysis Payment System

Cited by 50 publications

References 15 publications

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

International Comparisons to Assess Effects of Payment and Regulatory Changes in the United States on Anemia Practice in Patients on Hemodialysis: The Dialysis Outcomes and Practice Patterns Study

Has Dialysis Payment Reform Led to Initial Racial Disparities in Anemia and Mineral Metabolism Management?

Comparing Mandated Health Care Reforms

Contact Info

Product

Resources

About