Does the Medicare expanded dialysis prospective payment system impact PD discontinuation and patient mortality in ESKD patients?
The expansion of peritoneal dialysis use under the new Medicare payment system was associated with a decreased risk of PD discontinuation and no adverse effect on mortality, despite an increase in patients treated at less experienced facilities.
BACKGROUND AND OBJECTIVES: Peritoneal dialysis (PD) use increased in the United States with the introduction of a new Medicare prospective payment system in January 2011 that likely reduced financial disincentives for facility use of this home therapy. The expansion of PD to a broader population and facilities having less PD experience may have implications for patient outcomes. We assessed the impact of PD expansion on PD discontinuation and patient mortality. DESIGN, SETTING, PARTICIPANTS, 95% confidence interval 95% CI, 1. 10 to 1. 23 for the first versus fifth quintile of PD experience). Nevertheless, the risk of PD discontinuation fell during the late interim period (HR, 0. 88; 95% CI, 0. 82 to 0. 95) and most of the reform period (from HR, 0. 85; 95% CI, 0. 79 to 0. 91 to HR, 0. 94; 95% CI, 0. 87 to 1. 01). Mortality risk was stable across the three study periods. CONCLUSIONS: In the context of expanding PD use and declining facility PD experience, the risk of PD discontinuation fell, and there was no adverse effect on mortality. PODCAST: This article contains a podcast at https: //www. asn-online. org/media/podcast/CJASN/2019₀9₁2CJN01610219. mp3.
Young et al. (2019) studied this question.