What can we learn from the U.S. expanded end-stage renal disease bundle?

Health Policy

Volumn 110, Issue 2-3, 2013, Pages 164-171

  Chambers, James D ^a   Weiner, Daniel E ^a   Bliss, Sarah K ^a   Neumann, Peter J ^a  

^a TUFTS MEDICAL CENTER   (United States)

Author keywords

Bundled payment; End stage renal disease; Episode based payment; Medicare; Payment reform

Indexed keywords

ANTIANEMIC AGENT; HEMOGLOBIN;

ACCOUNTABLE CARE ORGANIZATION; ACCOUNTING; ARTICLE; COST CONTROL; COST OF ILLNESS; GERIATRIC PATIENT; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HEALTH SERVICE; HEMODIALYSIS; HEMODIALYSIS PATIENT; HEMOGLOBIN BLOOD LEVEL; HOME DIALYSIS; HOSPITAL DEPARTMENT; HUMAN; KIDNEY FAILURE; LIFE EXPECTANCY; MEDICARE; PERITONEAL DIALYSIS; PROSPECTIVE PAYMENT; RENAL REPLACEMENT THERAPY;

COST CONTROL; DELIVERY OF HEALTH CARE; HUMANS; KIDNEY FAILURE, CHRONIC; MEDICARE; PROSPECTIVE PAYMENT SYSTEM; REIMBURSEMENT MECHANISMS; RENAL DIALYSIS; UNITED STATES;

EID: 84876151489     PISSN: 01688510     EISSN: 18726054     Source Type: Journal    
DOI: 10.1016/j.healthpol.2013.01.011     Document Type: Article

References (44)

1. Chapter 4. A path to bundled payment around a hospitalization. Report to the Congress: reforming the delivery system. Washington, D.C.: Medicare Payment Advisory Committee; 2008.
2. Revisiting the state of the science: the effects of bundled payment strategies on health care spending and quality of care, 3-16, AHRQ, Effective Health Care Program, Closing the Quality Gap Series; 2011. 9-22-2011.
3. Sood N., Huckfeldt P.J., Escarce J.J., Grabowski D.C., Newhouse J.P. Medicare's bundled payment pilot for acute and postacute care: analysis and recommendations on where to begin. Health Affairs (Millwood) 2011, 30(9):1708-1717.
4. Averill R.F., Goldfield N.I., Hughes J.S., Eisenhandler J., Vertrees J.C. Developing a prospective payment system based on episodes of care. Journal of Ambulatory Care Management 2009, 32(3):241-251.
5. Hussey P.S., Sorbero M.E., Mehrotra A., Liu H., Damberg C.L. Episode-based performance measurement and payment: making it a reality. Health Affairs (Millwood) 2009, 28(5):1406-1417.
6. Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program: End-stage renal disease prospective payment system, final rule, 42 CFR Parts 410, 413 and 414, 49030-49214. Department of Health and Human Services, Center for Medicaid and Medicare Services; 8-12-2010.
7. Blagg C.R. The early history of dialysis for chronic renal failure in the United States: a view from Seattle 135. American Journal of Kidney Diseases 2007, 49(3):482-496.
8. Rettig R.A. The politics of health cost containment: end-stage renal disease. Bulletin of the New York Academy of Medicine 1980, 56(1):115-138.
9. Collins A.J., Foley R.N., Chavers B., Gilbertson D., Herzog C., Johansen K., et al. United States Renal Data System 2011 Annual Data Report: atlas of chronic kidney disease and end-stage renal disease in the United States. American Journal of Kidney Diseases 2012, 59(1 Suppl. 1):A1-A7. e1-e420.
10. Leavitt MO. Report to Congress: a design for a bundled end stage renal disease prospective payment system; 2008. [Accessed 20 January 2012]. http://www.cms.gov/Medicare/End-Stage-Renal-Disease/ESRDGeneralInformation/downloads/ESRDReportToCongress.pdf.
11. Collins A.J., Foley R.N., Herzog C., Chavers B., Gilbertson D., Ishani A., et al. US Renal Data System 2010 Annual Data Report. American Journal of Kidney Diseases 2011, 57(1 Suppl. 1):A1-A8. e1-e526.
12. Iglehart J.K. Bundled payment for ESRD - including ESAs in Medicare's dialysis package. New England Journal of Medicine 2011, 364(7):593-595.
13. Klepner J., Nord B. End-stage renal disease reform moves into the regulatory process. Dialysis & Transplantation 2008, 37(11):446.
14. Steinbrook R. Medicare and erythropoietin. New England Journal of Medicine 2007, 356(1):4-6.
15. Swaminathan S., Mor V., Mehrotra R., Trivedi A. Medicare's payment strategy for end-stage renal disease now embraces bundled payment and pay-for-performance to cut costs. Health Affairs (Millwood) 2012, 31(9):2051-2058.
16. Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program: End-stage renal disease quality incentive program. Berwick D, Sebelius K, editors. Federal Register 413[155]; 8-12-2010. p. 49215-49232.
17. Miller H.D. From volume to value: better ways to pay for health care. Health Affairs (Millwood) 2009, 28(5):1418-1428.
18. CMS Medicare Demonstration Projects & Evaluation Reports - overview; 2011. [Accessed 20 January 2012]. https://www.cms.gov/DemoProjectsEvalRpts/01_Overview.asp.
19. CMS. Medicare acute care episode demonstration for orthopedic and cardiovascular surgery; 2012. 8-1-2012.
20. HCFA. Medicare Participating Heart Bypass Center Demonstration; 1998. 8-1-2012.
21. Medicare Claims Processing Manual. Chapter 8 - outpatient ESRD hospital, independent facility, and physician/supplier claims, 140-monthly capitation payment method for physicians' services furnished to patients on maintenance dialysis; 11-25-2011. 8-1-2012.
22. Medicare. Acute care hospital inpatient prospective payment system; 2012.
23. Collins AJ. ESRD payment policy changes: the new " bundled" dialysis prospective payment system (PPS) in the United States, National Kidney Foundation Spring Clinical Meeting Presentation 2012; 2012.
24. Pisoni R.L., Fuller D.S., Bieber B.A., Gillespie B.W., Robinson B.M. The DOPPS Practice Monitor for US dialysis care: trends through August 2011. American Journal of Kidney Diseases 2012, 60(1):160-165.
25. Transition in service utilization: vascular access, injectables, hemoglobin levels, and transfusions. 2012 United States Renal Data System (USRDS) annual presentations; 2012.
26. Weiner D.E., Winkelmayer W.C. Commentary on 'The DOPPS practice monitor for US dialysis care: trends through August 2011': an ESA confluence. American Journal of Kidney Diseases 2012, 60(1):165-167.
27. Fuller D.S., Pisoni R.L., Bieber B.A., Gillespie B.W., Robinson B.M. The DOPPS practice monitor for US dialysis care: trends through December 2011. American Journal of Kidney Diseases 2013, 61(2):342-346.
28. Spolter Y.S., Seliger S.L., Zhan M., Hsu V.D., Walker L.D., Fink J.C. The relationship between dialysis performance measures: adequacy and anemia management. American Journal of Kidney Diseases 2007, 50(5):774-781.
29. The Lewin Group, KuhmerKer K., Teisl J. Bending the health care cost curve in New York State: implementation plan to adopt bundled payment methods, 3-5 2010, NYS Health Foundation, New York, 8-19-0011.
30. Levinson DR. Medicare reimbursement for end stage renal disease drugs. Third Quarter 2006; 2011.
31. DaVita to Acquire DSI Renal, Inc. Business Wire; 2011. 2-4-2011.
32. Renal advantage and liberty dialysis agree to combine to become the 3rd largest dialysis provider. PR Newswire; 2010. 11-4-2010.
33. Weiner D.E. The 2011 ESRD prospective payment system: welcome to the bundle 136. American Journal of Kidney Diseases 2011, 57(4):539-541.
34. Pham HH, Ginsburg PB, Lake TK, Maxfield MM. Episode-based payments: charting a course for health care payment reform. Policy Analysis No. 1. National Institute for Health Care Reform; 2010.
35. Lacson E., Hakim R.M. The 2011 ESRD prospective payment system: perspectives from Fresenius Medical Care, a large dialysis organization 139. American Journal of Kidney Diseases 2011, 57(4):547-549.
36. Ibrahim H.N., Ishani A., Foley R.N., Guo H., Liu J., Collins A.J. Temporal trends in red blood transfusion among US dialysis patients, 1992-2005. American Journal of Kidney Diseases 2008, 52(6):1115-1121.
37. Medicare improvements for patients and providers act of 2008, H.R. 6331; 2008. p. 60-7. 9-28-2010.
38. Patient protection and affordable care act, 3590; 2010.
39. Report to the Congress: reforming the delivery system 14. Washington, D.C.: Medicare Payment Advisory Committee; 2008. 9-29-2010.
40. Evans J. The current state of bundled payment. American Health & Drug Benefit 2010, 3(4):292.
41. Ginsburg P.B. Shopping for price in medical care. Health Affairs (Millwood) 2007, 26(2):w208-w216.
42. Bach P.B., Mirkin J.N., Luke J.J. Episode-based payment for cancer care: a proposed pilot for Medicare 133. Health Affairs (Millwood) 2011, 30(3):500-509.
43. McClellan M., McKethan A.N., Lewis J.L., Roski J., Fisher E.S. A national strategy to put accountable care into practice 140. Health Affairs (Millwwod) 2010, 29(5):982-990.
44. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of the Inspector General. Medicare program; medicare shared savings program: accountable care organizations, proposed rule, 42 CFR Part 42; 2011. 9-23-0011.