title: Economic impact of case-mix adjusting the dialysis composite rate.
abstract: The Medicare program reimburses dialysis providers a flat rate for a bundle of services that comprise the basic dialysis treatment. This payment system is being modified to incorporate case-mix adjustment for age and body size, which have been shown to influence dialysis costs. This study simulated the economic impact of the recently issued Medicare rule on case-mix adjustment by estimating the variation in payments across patients, facilities, and broad classes of facilities. Case-mix adjustment results in considerable patient-level variation in payments (dollar 12.99 SD in case-mix adjusted payments). The variation across dialysis facilities is smaller but still economically significant (dollar 3.77 SD). However, there was little evidence that particular classes of facilities (e.g., ownership, chain membership, size) will be substantially advantaged or disadvantaged by case-mix adjustment. There do seem to be modest changes in the regional distribution of payments.
authors.affiliation: Kidney Epidemiology and Cost Center, Department of Biostatistics, The University of Michigan School of Public Health, 315 West Huron, Suite 240, Ann Arbor, MI 48109-4262, USA. rhirth@umich.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hirth
authors.forename: Erik C
authors.initials: EC
authors.lastname: Roys
authors.forename: John R C
authors.initials: JR
authors.lastname: Wheeler
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Messana
authors.forename: Marc N
authors.initials: MN
authors.lastname: Turenne
authors.forename: Rajiv
authors.initials: R
authors.lastname: Saran
authors.forename: Alyssa S
authors.initials: AS
authors.lastname: Pozniak
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D017048:Health Care Costs; D006268:Health Facilities / Q000191:economics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics*; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence; D008875:Middle Aged; D011445:Prospective Payment System / Q000191:economics / Q000331:legislation & jurisprudence; D006435:Renal Dialysis / Q000191:economics*; D020379:Risk Adjustment / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States