Understanding the basic case-mix adjustment for the composite rate.
In April 2005, Medicare began adjusting payments to dialysis providers for composite-rate services for a limited set of patient characteristics, including age, body surface area, and low body mass index. We present analyses intended to help the end-stage renal disease community understand the empirical reasons behind the new composite-rate basic case-mix adjustment. The U-shaped relationship between age and composite-rate cost that is reflected in the basic case-mix adjustment has generated significant discussion within the end-stage renal disease community. Whereas greater costs among older patients are consistent with conventional wisdom, greater costs among younger patients are caused in part by more skipped sessions and a greater incidence of certain costly comorbidities. Longer treatment times for patients with a greater body surface area combined with the largely fixed cost structure of dialysis facilities explains much of the greater cost for larger patients. The basic case-mix adjustment reflects an initial and partial adjustment for the cost of providing composite-rate services.
Kidney Epidemiology and Cost Center and Internal Medicine, University of Michigan, Ann Arbor, MI, USA. jackwhee@umich.edu
John R C
JR
Wheeler
Joseph M
JM
Messana
Marc N
MN
Turenne
Richard A
RA
Hirth
Alyssa S
AS
Pozniak
Qing
Q
Pan
Chien-Chia
CC
Chuang
Kathryn
K
Slish
Philip
P
Tedeschi
Erik C
EC
Roys
Robert A
RA
Wolfe
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics*; D020379:Risk Adjustment; D014481:United States