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Introduction of the federal government’s prospective payment system for dialysis care (“bundling”) on January 1, 2011 has brought about a new frugality and cost-consciousness in the use of medications and other resources in the management of patients with end-stage renal disease (ESRD). Dialysis providers were now being challenged to control costs—especially those associated with medications—while providing quality care.

“As a result of the bundle, medicines suddenly became a cost center versus a profit center,” said John Burkart, MD, Chief Medical Office for Health Systems Management at Wake Forest University Medical Center in Winston-Salem, North Carolina, who oversees the university’s outpatient dialysis facilities.

Faced with fixed payments for services, dialysis providers starting taking a hard look at whether one medicine really is more beneficial than another, or whether prescribing medications to achieve the highest possible value of a laboratory metric makes a meaningful clinical difference.

“The pharmaceutical industry adjusted to that and changed the way things were packaged, changed the way things were marketed, changed what was available for a dialysis unit, whereas before maybe it wasn’t available for a dialysis unit.”

Rob Chioini, Chief Executive Officer for Rockwell Medical, Inc., a maker of dialysis products, noted, “As a pharma company, we started looking for products or ways that could demonstrate cost savings to providers while still improving patient outcomes.”

“I think bundling gave us the first look at what happens when you’re held accountable for clinical outcomes and for resource stewardship,” said Allen R. Nissenson, MD, Chief Medical Officer of Kidney Care for DaVita HealthCare Partners, Inc. The introduction of bundling has encouraged dialysis providers to focus on how they can achieve the best patient outcomes while restraining costs, he said.

“The challenges around a bundled system’s payment constraints are balanced by the move toward value-based care models,” said Franklin W. Maddux, MD, Executive Vice President of Clinical & Scientific Affairs and Chief Medical Officer for Fresenius Medical Care North America. “These new models afford the ability to add innovation investments that address the greater risk and responsibility providers assume in managing the total cost of care for our patients.”

The bundled payment includes all renal dialysis services provide for outpatient maintenance dialysis, including drugs and biologicals (except oral-only medications until 2025) and other renal dialysis items and services that used to be payable separately. The Centers for Medicare & Medicaid Services (CMS), which oversees reimbursement for dialysis care, said it expects to pay about $9 billion to approximately 6000 dialysis facilities in 2017 for costs associated with the provision of dialysis care. The bundle base rate for 2016 was $230.39; the proposed base rate for 2017 is $231.04. The bundled payment is case-mix adjusted for various factors relating to patient characteristics. CMS also makes facility-level adjustments for dialysis facilities that have a low patient volume or rural locality.

Source: Jody A. Charnow, Editor, March 02, 2017, Renal and Urology News


For Further Information
More on the dialysis device market in the U.S. can be found in a series of reports published by iData Research entitled the US Market Report Suite for Dialysis Devices and Concentrates. The suite covers reports on the following markets: hemodialysis and peritoneal dialysis machines, dialysis catheters, dialyzers, dialyzer reprocessing machines, hemodialysis bloodline and tubing sets, AV fistula needles, AV access grafts, declotting devices, introducer sheaths and guidewires and water treatment systems.

The iData report series on hearing devices covers the U.S. and Canada. Reports provide a comprehensive analysis including units sold, procedure numbers, market value, forecasts, as well as detailed competitive market shares and analysis of major players’ success strategies in each market and segment. To find out more about dialysis device market data or procedure data, register online or email us at [email protected] for a US Market Report Suite for Dialysis Device and Concentrates brochure and synopsis.

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