Use of Peritoneal Dialysis Up Since Medicare Payment Reform
More patients initiated peritoneal dialysis, switched to peritoneal dialysis after PPS initiation
FRIDAY, Nov. 22, 2019 (HealthDay News) -- Following Medicare payment reform for dialysis, more patients started, stayed on, and switched to peritoneal dialysis (PD), according to a study published online Nov. 21 in the Clinical Journal of the American Society of Nephrology.
Caroline E. Sloan, M.D., from the Duke University School of Medicine in Durham, North Carolina, and colleagues examined the impact of the 2011 Medicare prospective payment system (PPS) for dialysis on PD initiation, modality switches, and stable PD use. Data were included for 619,126 U.S. patients with end-stage kidney disease initiating dialysis before (2006 to 2010) and after (2011 to 2013) implementation of the PPS.
The researchers observed an increase in early PD experience (any PD one to 90 days after initiation) from 9.4 percent before PPS to 12.6 percent after PPS. An increase in late PD (any PD 91 to 730 days after initiation) was also seen, from 12.1 to 16.1 percent. PPS correlated with increased early PD experience and late PD use in adjusted analyses (odds ratios, 1.51 and 1.47, respectively). The increase in late PD use was partly due to an increase in hemodialysis (HD)-to-PD switches among those without early PD experience and a reduction in PD-to-HD switches in those with early PD experience (odds ratios, 1.59 and 0.92, respectively).
"In summary, our study found that more patients are now starting, staying on, and switching to PD than before the PPS was implemented, achieving a goal of payment reform," the authors write.
One author disclosed financial ties to the pharmaceutical industry.