US Renal Data System 2010 Annual Data Report

Collins, Allan J.; Foley, Robert N.; Herzog, Charles A.; Chavers, Blanche M.; Gilbertson, David T.; Ishani, Areef; Kasiske, Bertram L.; Liu, Jiannong; Mau, Lih Wen; McBean, Marshall; Murray, Anne M.; Peter, Wendy L. St.; Guo, Haifeng; Gustafson, S. K.; Li, Qi; Li, Shuling; Li, Suying; Peng, Yen‐Chun; Qiu, Yang; Roberts, Tricia; Skeans, M. A.; Snyder, Jon J.; Solid, Craig A.; Wang, Changchun; Weinhandl, Eric D.; Zaun, David; Arko, Cheryl; Chen, Shu‐Cheng; Dalleska, Frederick; Daniels, Frank; Dunning, Stephan; Ebben, James; Frazier, Eric; Hanzlik, Christopher; Johnson, Roger N.; Sheets, Daniel; Wang, Xinyue; Forrest, Beth; Constantini, Edward; Everson, Susan; Eggers, Paul W.; Agodoa, Lawrence Y.

doi:10.1053/j.ajkd.2010.10.007

Cited by 316 publications

(305 citation statements)

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“…The program provides universal coverage for ESRD patients regardless of age or disability status. As with many elements of Medicare, the ESRD Program's costs far exceeded expectations, currently accounting for approximately 7% of Medicare spending for ,1% of beneficiaries (5,6).…”

Section: Organization Payment Mechanisms and Cost Controlmentioning

confidence: 99%

“…Until 2010, the dialysis facility payment had the following two components: a "composite rate" for many dialysis-related services, plus a "separately billable" fee-for-service component for injectable medications and some laboratory tests (Table 2) (7-9). (6). However, because ESAs were separately billable items, there was a powerful financial incentive for overutilization because they were a major profit source for dialysis providers (9).…”

Section: Organization Payment Mechanisms and Cost Controlmentioning

confidence: 99%

“…Increased use of home dialysis as a result of restructuring dialysis payment could achieve the ultimate goal of health reform, which is to reduce costs while maintaining, or perhaps even improving, the quality of care. However, it remains unknown whether the comparable outcomes and lower costs currently associated with home dialysis will be sustained if its utilization grows (6). To note, dialysis providers, not the CMS, will recognize the cost savings with this group of dialysis patients because the CMS will be paying equivalent bundles to dialysis providers, regardless of modality.…”

Section: Monitoring the Effects Of Policy Changesmentioning

confidence: 99%

“…Currently, significant industry consolidation exists among dialysis providers in the United States with two for-profit corporations providing care for .70% of patients (6). Smaller dialysis providers may have limited resources to execute new bundle-related responsibilities and to assume greater shared risk.…”

Section: Economies Of Scale "Desirable" Patients and Equitable Accessmentioning

confidence: 99%

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Comparing Mandated Health Care Reforms

Watnick

Weiner

Shaffer

et al. 2012

Clinical Journal of the American Society of Nephrology

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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.

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Section: Organization Payment Mechanisms and Cost Controlmentioning

confidence: 99%

Section: Organization Payment Mechanisms and Cost Controlmentioning

confidence: 99%

Section: Monitoring the Effects Of Policy Changesmentioning

confidence: 99%

Section: Economies Of Scale "Desirable" Patients and Equitable Accessmentioning

confidence: 99%

See 2 more Smart Citations

Comparing Mandated Health Care Reforms

Watnick

Weiner

Shaffer

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…The morbidity and mortality rates of TB are high, particularly in patients of reproductive age, which results in increased treatment costs for CKD patients and renders TB a serious public health problem [6][7][8] .…”

mentioning

confidence: 99%

Prevalence of latent tuberculosis and treatment adherence among patients with chronic kidney disease in Campo Grande, State of Mato Grosso do Sul

Chagas

Filho

Oliveira

et al. 2014

Rev. Soc. Bras. Med. Trop.

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Frailty, Dialysis Initiation, and Mortality in End-Stage Renal Disease

Bao¹,

Dalrymple²,

Chertow³

et al. 2012

Arch Intern Med

298

286

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Background In light of the recent trend toward earlier dialysis initiation and its association with mortality among patients with end-stage renal disease, we hypothesized that frailty is associated with higher estimated glomerular filtration rate (eGFR) at dialysis start and may confound the relation between earlier dialysis initiation and mortality. Methods We examined frailty among participants of the Comprehensive Dialysis Study (CDS), a special study of the US Renal Data System, which enrolled incident patients from September 1, 2005, through June 1, 2007. Patients were followed for vital status through September 30, 2009, and for time to first hospitalization through December 31, 2008. We used multivariate logistic regression to model the association of frailty with eGFR at dialysis start and proportional hazards regression to assess the outcomes of death or hospitalization. Results Among 1576 CDS participants included, the prevalence of frailty was 73%. In multivariate analysis, higher eGFR at dialysis initiation was associated with higher odds of frailty (odds ratio [OR], 1.44 [95% CI, 1.23–1.68] per 5 mL/min/1.73 m2; P<.001). Frailty was independently associated with mortality (hazard ratio [HR], 1.57 [95% CI, 1.25–1.97]; P<.001) and time to first hospitalization (HR, 1.26 [95% CI, 1.09–1.45]; P<.001). While higher eGFR at dialysis initiation was associated with mortality (HR, 1.12 [95% CI, 1.02–1.23] per 5 mL/min/1.73 m2; P=.02), the association was no longer statistically significant after frailty was accounted for (HR, 1.08 [95% CI, 0.98–1.19] per 5 mL/min/1.73 m2; P=.11). Conclusions Frailty is extremely common among patients starting dialysis in the United States and is associated with higher eGFR at dialysis initiation. Recognition of signs and symptoms of frailty by clinicians may prompt earlier initiation of dialysis and may explain, at least in part, the well-described association between eGFR at dialysis initiation and mortality.

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US Renal Data System 2010 Annual Data Report

Cited by 316 publications

References 0 publications

Comparing Mandated Health Care Reforms

Comparing Mandated Health Care Reforms

Prevalence of latent tuberculosis and treatment adherence among patients with chronic kidney disease in Campo Grande, State of Mato Grosso do Sul

Frailty, Dialysis Initiation, and Mortality in End-Stage Renal Disease

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