Tuesday, 4 August 2009

Incentives for home dialysis – End stage renal disease: CMS should monitor effect of bundled payment on home haemodialysis utilisation rates

This report from the United States Government accountability office makes interesting reading. In the USA approximately 92% of people receive their dialysis in a hospital or satellite unit, while about 7.4% perform peritoneal dialysis at home and only 0.7% receive home haemodialysis. The CMS, the agency that pays for dialysis wants to create incentives for providers to offer home dialysis and already requires providers to offer home dialysis or indicate why individual patients are unsuitable. Many of the medical experts and dialysis providers interviewed for this report estimate that from 15-35% of all dialysis patients would be good candidates for home dialysis.

Average costs per treatment for haemodialysis in a facility, is quoted at $243 versus $133 for haemodialysis at home, with peritoneal dialysis at home averaging $94. In the USA, training is billed separately, for instance $20 per training session to train a patient how to conduct haemodialysis, for 3 sessions per week for up to 3 months.

We have been looking at the findings in the Dialysis Best Practice Tariff Group to see what parallels there might be for our system. In the USA they have decided to bundle payments and will be monitoring the impact – I and I am sure others will be watching this with interest.