title: Hemodialysis Hospitalizations and Readmissions: The Effects of Payment Reform.
abstract: BACKGROUND
  In 2004, the Centers for Medicare & Medicaid Services changed reimbursement for physicians and advanced practitioners caring for patients receiving hemodialysis from a capitated to a tiered fee-for-service system, encouraging increased face-to-face visits. This early version of a pay-for-performance initiative targeted a care process: more frequent provider visits in hemodialysis. Although more frequent provider visits in hemodialysis are associated with fewer hospitalizations and rehospitalizations, it is unknown whether encouraging more frequent visits through reimbursement policy also yielded these benefits.
  
  
  METHODS
  We used a retrospective cohort interrupted time-series study design to examine whether the 2004 nephrologist reimbursement reform led to reduced hospitalizations and rehospitalizations. We also used published data to estimate a range of annual economic costs associated with more frequent visits.
  
  
  METHODS
  Medicare beneficiaries in the United States receiving hemodialysis in the 2 years prior to and following reimbursement reform.
  
  
  METHODS
  The 2 years following nephrologist reimbursement reform.
  
  
  RESULTS
  Odds of hospitalization and 30-day hospital readmission for all causes and fluid overload; US dollars.
  
  
  RESULTS
  We found no significant change in all-cause hospitalization or rehospitalization and slight reductions in fluid overload hospitalization and rehospitalization following reimbursement reform; the estimated economic cost associated with additional visits ranged from $13 to $87 million per year, depending on who (physicians or advanced practitioners) spent additional time visiting patients and how much additional effort was involved.
  
  
  CONCLUSIONS
  Due to limited information about how much additional time providers spent seeing patients after reimbursement reform, we could only examine a range of potential economic costs associated with the reform.
  
  
  CONCLUSIONS
  A Medicare reimbursement policy designed to encourage more frequent visits during outpatient hemodialysis may have been costly. The policy was associated with fewer hospitalizations and rehospitalizations for fluid overload, but had no effect on all-cause hospitalizations or rehospitalizations.
authors.affiliation: Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety, Baylor College of Medicine, Houston, TX. Electronic address: kevin.erickson@bcm.edu.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Erickson
authors.affiliation: Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX.
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
mesh_terms: D015331:Cohort Studies; D018588:Fee-for-Service Plans; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000191:economics*; D012189:Retrospective Studies
keywords: Hemodialysis; Quality Incentive Program (QIP); economic incentives; end-stage renal disease (ESRD); fee-for-service; fluid overload; health care costs; health policy; pay for performance (P4P); payment reform; physician reimbursement; physician visit frequency; rehospitalization