EXTON, Pa.—Medical directors report a significantly higher awareness of the dialysis bundle and have become decidedly more negative about the impact to patient outcomes, according to new results released March 24 by BioTrendsResearch Group.
BioTrends surveyed 150 medical directors and 100 renal administrators across dialysis facilities in the United States about the bundle. In addition, interviews were conducted with key stakeholders (renal organizations, dialysis company executives, key opinion leaders and commercial payers).
The overall goal of the research study is to follow awareness about the bundle, understand how practice patterns may be affected and understand the greatest perceived risks and opportunities that will be presented with this new payment structure.
Close to three-quarters of the respondents now expect bundling to have a “negative” impact on patient outcomes, compared to 43 percent in June 2009, when BioTrends first surveyed renal professionals on this subject. An area of particular concern for the research participants is the inclusion of oral medications (phosphate binders and cinacalcet) in the proposed rule, which was released in September 2009.
The Centers for Medicare & Medicaid Services will be implementing the new payment system on Jan. 1, 2011 and will phase the program in over a four-year period. The new payment system will create a single per-treatment case-mix adjusted payment for ESRD that encompasses dialysis services, relevant diagnostic and clinical laboratory tests and dialysis-related drugs.
Almost half of the respondents indicated active or planned pilot programs to evaluate the impact of various clinical strategies under the new payment system. A majority of respondents anticipate a decrease in the use of ESAs through a shift to subcutaneous dosing, potentially lower hemoglobin targets and dose limitations in select patients. In bone and mineral metabolism, more than half of the medical directors suggest that a shift to calcitriol (from Abbott’s Zemplar and Genzyme’s Hectorol) is likely and a major offset to Amgen’s Sensipar is projected.
And although an increase in the use of calcium-based phosphate binders was deemed to be “not in the best interest of the patient” by a majority of medical directors, future market share projections indicate increased use of these agents in place of more expensive, non-calcium agents such as Genzyme’s Renagel/Renvela and Shire’s Fosrenol.
The third wave of this research will be fielded following the release of the final rule which is expected in the next few months.
