Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD

Copyright © 2020 by the American Society of Nephrology..

BACKGROUND AND OBJECTIVES: Because of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011-when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care-payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans' access to dialysis care and mortality.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An interrupted time series design and VA, Medicare, and US Renal Data System data were used to identify veterans who received VA-financed dialysis in community-based dialysis facilities before (2006-2008), during (2009-2010), and after the enactment of VA policies to standardize dialysis payments (2011-2016). We used multivariable, differential trend/intercept shift regression models to examine trends in average reimbursement for community-based dialysis, access to quality care (veterans' distance to community dialysis, number of community dialysis providers, and dialysis facility quality indicators), and 1-year mortality over this time period.

RESULTS: Before payment reform, the unadjusted average per-treatment reimbursement for non-VA dialysis care varied widely ($47-$1575). After payment reform, there was a 44% reduction ($44-$250) in the adjusted price per dialysis session (P<0.001) and less variation in payments for dialysis ($73-$663). Over the same time period, there was an increase in the number of community dialysis facilities contracting with VA to deliver care to veterans with ESKD from 19 to 37 facilities (per VA hospital), and there were no changes in either the quality of community dialysis facilities or crude 1-year mortality rate of veterans (12% versus 11%).

CONCLUSIONS: VA policies to standardize payment and establish national dialysis contracts increased the value of VA-financed community dialysis care by reducing reimbursement without compromising access to care or survival.

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:15

Enthalten in:

Clinical journal of the American Society of Nephrology : CJASN - 15(2020), 11 vom: 06. Nov., Seite 1631-1639

Sprache:

Englisch

Beteiligte Personen:

Wang, Virginia [VerfasserIn]
Swaminathan, Shailender [VerfasserIn]
Corneau, Emily A [VerfasserIn]
Maciejewski, Matthew L [VerfasserIn]
Trivedi, Amal N [VerfasserIn]
O'Hare, Ann M [VerfasserIn]
Mor, Vincent [VerfasserIn]

Links:

Volltext

Themen:

Dialysis
Health Services Accessibility
Journal Article
Mortality
Research Support, U.S. Gov't, Non-P.H.S.
Veterans

Anmerkungen:

Date Completed 22.11.2021

Date Revised 21.04.2023

published: Print-Electronic

Citation Status MEDLINE

doi:

10.2215/CJN.02100220

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM315342013