Does the 2011 Medicare prospective payment system (PPS) increase peritoneal dialysis use in US patients with incident ESKD?
The 2011 Medicare prospective payment system for dialysis was associated with increased initiation, continuation, and switching to peritoneal dialysis among incident ESKD patients in the US.
Background and objectives Peritoneal dialysis (PD) for ESKD is associated with similar mortality, higher quality of life, and lower costs compared with hemodialysis (HD), but has historically been underused. We assessed the effect of the 2011 Medicare prospective payment system (PPS) for dialysis on PD initiation, modality switches, and stable PD use. Design, setting, participants, 95% confidence interval 95% CI, 1.47 to 1.55; P <0.001) and late PD use (OR, 1.47; 95% CI, 1.45 to 1.50; P <0.001). In subgroup analyses, late PD use increased in part due to an increase in HD-to-PD switches among those without early PD experience (OR, 1.59; 95% CI, 1.52 to 1.66; P <0.001) and a decrease in PD-to-HD switches among those with early PD experience (OR, 0.92; 95% CI, 0.87 to 0.98; P =0.004). Conclusions More patients started, stayed on, and switched to PD after dialysis payment reform. This occurred without a substantial increase in transfers to HD.
Sloan et al. (2019) studied this question.