Beginning in 2011, Medicare will begin paying for dialysis services for individuals with end-stage renal disease using an expanded bundled payment that is designed to encourage home dialysis.
However, several factors could make those home services somewhat more expensive—and less desirable to providers—according to a new General Accounting Office report.
Some dialysis experts and providers have estimated that anywhere from less than 10% to up to 50% of dialysis patients could be good candidates to perform dialysis at home. Currently, only about 8% of individuals undergoing dialysis do it at home. In 2006, Medicare was the primary payer for approximately 84% of dialysis patients nationwide.
Currently, the details of the bundled payment are still under development, according to officials from the Centers for Medicare and Medicaid Services. At the time of the GAO review, CMS indicated it might give providers the same payment regardless of whether the dialysis was performed at home or in a facility.
CMS officials acknowledged to GAO that while some costs might be higher for home dialysis patients—such as supplies—other costs would be far less. These costs would be offset by efficiencies created in lower-cost categories, such as drugs, staff, and overhead projections, according to CMS.
However, costs related to training patients how to perform dialysis at home could make treatment costs higher, according to the providers interviewed by GAO staff. For instance, it may take three to six weeks, with up to five training sessions per week, to train a patient to perform home dialysis. For those performing peritoneal dialysis, the training period might be about one to two weeks.
Also, patients undergoing treatments at home may perform them more than three times a week (which is the average for dialysis procedures performed in facilities). Charges for single dialysis treatments performed in a facility are higher (about $240 on average), compared to treatments at home (between $90 to $130). However, weekly costs could end up the same or more depending on how often treatments were performed at home.
GAO recommended that CMS should establish and implement a formal plan to monitor the bundled payment system's effect on home dialysis utilization rates and determine whether home dialysis utilization rates may be higher than initially estimated.