title: Clinical and economic value of performing dialysis vascular access procedures in a freestanding office-based center as compared with the hospital outpatient department among Medicare ESRD beneficiaries.
abstract: Dialysis vascular access (DVA) care is being increasingly provided in freestanding office-based centers (FOC). Small-scale studies have suggested that DVA care in a FOC results in favorable patient outcomes and lower costs. To further evaluate this issue, data were drawn from incident and prevalent ESRD patients within a 4-year sample (2006-2009) of Medicare claims (USRDS) on cases who receive at least 80% of their DVA care in a FOC or a hospital outpatient department (HOPD). Using propensity score matching techniques, cases with a similar clinical and demographic profile from these two sites of service were matched. Medicare utilization, payments, and patient outcomes were compared across the matched cohorts (n = 27,613). Patients treated in the FOC had significantly better outcomes (p < 0.001), including fewer related or unrelated hospitalizations (3.8 vs. 4.4), vascular access-related infections (0.18 vs. 0.29), and septicemia-related hospitalizations (0.15 vs. 0.18). Mortality rate was lower (47.9% vs. 53.5%) as were PMPM payments ($4,982 vs. $5,566). This study shows that DVA management provided in a FOC has multiple advantages over that provided in a HOPD.
authors.affiliation: Dobson DaVanzo & Associates, LLC.
authors.forename: Al
authors.initials: A
authors.lastname: Dobson
authors.forename: Audrey M
authors.initials: AM
authors.lastname: El-Gamil
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Shimer
authors.forename: Joan E
authors.initials: JE
authors.lastname: DaVanzo
authors.forename: Aris Q
authors.initials: AQ
authors.lastname: Urbanes
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Beathard
authors.forename: Terry Foust
authors.initials: TF
authors.lastname: Litchfield
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D057216:Propensity Score; D006435:Renal Dialysis / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D062666:Vascular Access Devices / Q000191:economics*