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Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD
- Source :
- Clin J Am Soc Nephrol
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- 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
- Subjects :
- Male
medicine.medical_specialty
Epidemiology
media_common.quotation_subject
Dialysis care
Critical Care and Intensive Care Medicine
Ambulatory Care Facilities
01 natural sciences
Health Services Accessibility
03 medical and health sciences
0302 clinical medicine
Renal Dialysis
Humans
Medicine
Limited capacity
030212 general & internal medicine
0101 mathematics
Dialysis facility
Veterans Affairs
health care economics and organizations
Reimbursement
Aged
Retrospective Studies
media_common
Transplantation
Payment reform
business.industry
010102 general mathematics
Interrupted Time Series Analysis
Original Articles
Contract Services
Middle Aged
Payment
humanities
United States
Survival Rate
United States Department of Veterans Affairs
Nephrology
Family medicine
Insurance, Health, Reimbursement
Kidney Failure, Chronic
Female
Dialysis (biochemistry)
business
Subjects
Details
- ISSN :
- 1555905X and 15559041
- Volume :
- 15
- Database :
- OpenAIRE
- Journal :
- Clinical Journal of the American Society of Nephrology
- Accession number :
- edsair.doi.dedup.....9a0faabc2da936144945401d13629ffa