title: Changes in Medicare reimbursement and patient-nephrologist visits, quality of care, and health-related quality of life.
abstract: BACKGROUND
  Medicare's reimbursement system was changed in January 2004 to encourage more frequent visits between dialysis patients and nephrologists. We sought to determine the impact of this policy change on patient-nephrologist visits, quality of care, and health-related quality of life.
  
  
  METHODS
  We examined visits and outcomes for 2,043 patients at 12 hemodialysis facilities in northeast Ohio for 12 months before and 7 months after the reimbursement change. For comparison of outcomes, we used linear, logistic, or negative binomial regression models (for continuous, binary, and rate outcomes, respectively) to assess the significance of changes across the 2 periods.
  
  
  RESULTS
  For patients seen before and after the reimbursement change for at least 6 months, the number of visits per patient-month increased from 1.52 before to 3.14 after (P < 0.001). The percentage of patients with no nephrologist visits per patient-month decreased from 16.6% before to 4.6% after (P < 0.001). However, there were no clinically important changes in Kt/V, albumin level, hemoglobin level, phosphorus level, calcium level, hemodialysis catheter use, ultrafiltration volume, shortened or skipped treatments, hospital admissions, hospitalization days, or health-related quality of life, including patient satisfaction.
  
  
  CONCLUSIONS
  Despite a marked increase in visits between patients and nephrologists, there was no clinically important impact on parameters related to quality of care or health-related quality of life. Additional work is needed to determine effective payment strategies to improve dialysis patient outcomes.
authors.affiliation: Division of Nephrology, Center for Reducing Health Disparities, MetroHealth Medical Center, Cleveland, OH 44109, USA.
authors.forename: Evelyn K
authors.initials: EK
authors.lastname: Mentari
authors.forename: Peter B
authors.initials: PB
authors.lastname: DeOreo
authors.forename: Andrew S
authors.initials: AS
authors.lastname: O'Connor
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Edmond S
authors.initials: ES
authors.lastname: Ricanati
authors.forename: Ashwini R
authors.initials: AR
authors.lastname: Sehgal
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D007674:Kidney Diseases / Q000191:economics* / Q000523:psychology / Q000628:therapy; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data*; D009819:Office Visits / Q000706:statistics & numerical data*; D011786:Quality Control; D011788:Quality of Life; D012051:Reimbursement Mechanisms; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology