Does One Size Fit All With the Effects of Payment Reform? Dialysis Facility Payer Mix and Anemia Management Under the Expanded Medicare Prospective Payment System
| Autor: | Brenda W. Gillespie, Marc N. Turenne, Jeffrey Pearson, Chad Cogan, Purna Mukhopadhyay, Charley Gaber |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Anemia medicine.medical_treatment media_common.quotation_subject Medicare Hemoglobins Young Adult 03 medical and health sciences 0302 clinical medicine Renal Dialysis medicine Humans 030212 general & internal medicine Dialysis facility Erythropoietin health care economics and organizations Dialysis Aged Quality of Health Care media_common Prospective Payment System Payment reform business.industry 030503 health policy & services Financial risk Public Health Environmental and Occupational Health Health Care Costs Middle Aged Payment medicine.disease United States Health equity Health Care Reform Family medicine Kidney Failure Chronic Female Prospective payment system 0305 other medical science business |
| Zdroj: | Medical Care. 57:584-591 |
| ISSN: | 0025-7079 |
| Popis: | BACKGROUND The effects of Medicare payment reforms aiming to improve the efficiency and quality of care by establishing greater financial accountability for providers may vary based on the extent and types of other coverage for their patient populations. Providers who are more resource constrained due to a less favorable payer mix face greater financial risks under such reforms. The impact of the expanded Medicare dialysis prospective payment system (PPS) on quality of care in independent dialysis facilities may vary based on the extent of higher payments from private insurers available for managing increased risks. OBJECTIVES To evaluate whether anemia outcomes for dialysis patients in independent facilities differ under the Medicare PPS based on facility payer mix. DESIGN We examined changes in anemia outcomes for 122,641 Medicare dialysis patients in 921 independent facilities during 2009-2014 among facilities with differing levels of employer insurance (EI). We performed similar analyses of facilities affiliated with large dialysis organizations, whose practices were not expected to change based on facility-specific payer mix. RESULTS Among independent facilities, similar modeled trends in low hemoglobin for all 3 facility EI groups in 2009-2010 were followed by increased low hemoglobin during 2012-2014 for facilities with lower EI (P |
| Databáze: | OpenAIRE |
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