title: Medicare Reimbursement Reform for Provider Visits and Health Outcomes in Patients on Hemodialysis.
abstract: The relation between the quantity of many healthcare services delivered and health outcomes is uncertain. In January 2004, the Centers for Medicare and Medicaid Services introduced a tiered fee-for-service system for patients on hemodialysis, creating an incentive for providers to see patients more frequently. We analyzed the effect of this change on patient mortality, transplant wait-listing, and costs. While mortality rates for Medicare beneficiaries on hemodialysis declined after reimbursement reform, mortality declined more - or was no different - among patients whose providers were not affected by the economic incentive. Similarly, improved placement of patients on the kidney transplant waitlist was no different among patients whose providers were not affected by the economic incentive; payments for dialysis visits increased 13.7% in the year following reform. The payment system designed to increase provider visits to hemodialysis patients increased Medicare costs with no evidence of a benefit on survival or kidney transplant listing.
authors.affiliation: Division of Nephrology and Centers for Health Policy and Primary Care and Outcomes Research, Departments of Medicine and Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Erickson
authors.affiliation: Division of Nephrology and Centers for Health Policy and Primary Care and Outcomes Research, Departments of Medicine and Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Division of Nephrology and Centers for Health Policy and Primary Care and Outcomes Research, Departments of Medicine and Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Division of Nephrology and Centers for Health Policy and Primary Care and Outcomes Research, Departments of Medicine and Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya