WASHINGTON—In a May report, the Government Accountability Office found that home dialysis is generally cheaper per treatment compared to in-center dialysis, but it also learned that providers have questioned whether a new reimbursement system can increase the use of the home option.
The use of home dialysis has been on the decline for years, but recent rule and payment changes have the potential to increase its use. In 2006, 92 percent of all dialysis patients received their care at a facility, while 7.4 percent were on peritoneal dialysis and 0.7 percent of patients were using home hemodialysis.
Last year, the Centers for Medicare & Medicaid Services updated the rules dialysis clinics must follow to receive reimbursement and required that all facilities inform patients about their dialysis options—at home and at the facility.
Also, a new payment bundle will go into affect in 2011 that will combine all dialysis costs into one payment. With the bundle, providers keep the difference in Medicare payment if they don’t use all of the money on a treatment. The GAO said that the expanded bundle would give clinicians more flexibility in decision making because incentives to provide a particular drug or treatment would be reduced.
However, questions remain on how CMS will monitor the bundle’s impact on home dialysis use and whether it is accurately tracking the costs of home dialysis as it develops the bundle.
To understand this better, the GAO interviewed 12 dialysis providers, as well as other industry leaders and associations about the use of home dialysis, which it defined as either peritoneal dialysis or home hemodialysis.
The GAO also looked at self-reported cost information between 2006 and 2008 from six, unnamed dialysis providers—including a large chain, a small nonprofit and a hospital-based provider. The analysis found that each provider reported lower cost per treatment for home dialysis when compared to in-center dialysis. Those amount varied by provider, though.
