Impact of reimbursement regulations on patient management.
The Medicare End-Stage Renal Disease (ESRD) Program has saved the lives of thousands of patients with chronic renal failure; however, the absolute cost of the program has steadily increased since its inception in 1972 and quickly exceeded all budget estimates, although the actual cost per patient has increased only 69%, which is less than half the inflation rate. Cost-containment efforts have resulted in progressive reductions in reimbursement provided by Medicare to both physicians and dialysis centers. The reimbursement amount per dialysis treatment--the largest component of ESRD expenditures--has actually decreased from $138 in 1974 to approximately $54 in 1991 when measured in constant dollars. It is likely that these reimbursement restrictions have negatively impacted the level of patient care; both mortality and morbidity rates in patients receiving chronic dialysis are increasing in the United States. This is a significant cause for concern, particularly as the mortality rates in other industrialized countries began much lower than the US rate and have continued to decline despite adding older and presumably sicker patients. Although the mortality rate may be affected by factors such as broader patient acceptance criteria, particularly the inclusion of older patients and those with serious comorbid conditions, and by an increase in transplantation rates, there is concern that a trend toward shorter dialysis times may, perhaps, result in inadequate dialysis treatment.
Hull
A R
AR
University of Texas Southwestern Medical School, Dallas.
D000293:Adolescent; D000328:Adult; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D012051:Reimbursement Mechanisms / Q000191:economics; D006435:Renal Dialysis / Q000191:economics*; D014481:United States