Globe1234
  • HOME
  • Specialists
  • Medicare
  • Salt etc.
  • More

Dialysis Patients

8/16/2013

0 Comments

 
Medicare is trying to cut the cost of serving dialysis patients by paying dialysis centers and kidney doctors for cutting costs, even if the patients die.

91% of dialysis patients do not participate in Accountable Care Organizations, which have their own incentives to cut costs, so Medicare is trying to set up groups just for kidney patients. These are called End Stage Renal Disease seamless care organizations (ESCO). 
Dialysis patients are "1.3% of the Medicare population and accounted for an estimated 7.5% of Medicare spending, totaling over $20 billion in 2010."

ESCOs will receive 50%-75% of Medicare's savings on dialysis patients, compared to baseline costs. "Members must place their fiduciary duty to the ESCO before the interests of any ESCO participant" (Medicare's explanatory slides p.39)

They have 23 quality measures, one of which is the death rate. Medicare has not yet announced the weight to be given each measure, but judging by weighting for Accountable Care quality measures, no one measure will have much weight, including the mortality rate, so ESCOs can meet quality standards without minimizing deaths. Since a death stops all costs, the financial rewards for death are large.

Each "beneficiary’s first visit to a given dialysis facility during a particular period will prospectively match that beneficiary to the dialysis facility, and by extension the ESCO, for the upcoming performance year" (Request for Applications-RFA p.12). So a patient can avoid the incentives by changing to another dialysis facility, not part of the same ESCO. An email from Dr. 
Alefiyah Mesiwala, Medicare's leader for the program, says, "Once a beneficiary is seen by an ESCO facility, they are then matched for the life of the entire model unless the beneficiary dies, has a transplant, or becomes ineligible as stated in the RFA. Once a beneficiary is aligned to a facility, even if that beneficiary visits multiple facilities or providers in a given performance year, all costs associated with that beneficiary will be attributed to the ESCO facility the beneficiary was initially matched to per the matching rules outlined in the RFA" (5/5/2014).

The "first visit" rule gives an incentive for dialysis centers to be unable to find space for high risk patients (old or with multiple sicknesses), so they go to another ESCO at least for the first visit.

When patients find themselves in an ESCO, patients can avoid the cost-cutting incentives by finding a dialysis center which is not part of the same ESCO, and using doctors who are also not part of that ESCO. These other centers and doctors will not face the conflict of interest of being rewarded for cutting costs, so patients are more able to trust their recommendations and treatment decisions.

Dialysis companies and researchers doubt the ESCOs will be successful.
0 Comments
    This site does not provide
    legal or medical advice.

    The site does not
    recommend doctors,
    hospitals or anyone. It
    summarizes information,
    mostly from Medicare, so
    you can decide.


    Dates are assigned
    arbitrarily to sort
    the articles.
     Most
    articles have been
    written or updated
    more recently.


    Like: Facebook, Twitter,
    Google+1
    , Reddit

    Pages

    All
    0verview
    1-updates
    About
    Accountable Care Org
    Aco
    Advance Directives
    Advocates
    Alternatives
    App
    Assisted Living
    Boards
    Citations
    Climate
    Comfort Care
    Comment To Medicare
    Concierge
    Contact
    Correlations
    Costs
    Courts
    Data
    Deaths
    Definitions
    Dentists
    Disaster
    Doctors
    Do Not Resuscitate
    Drug Interactions
    Drugs
    Ehr
    Electronic-records
    Emergency
    Ethics-guidance
    Excel
    Exclusions
    Financial
    Foia
    Foreign
    Fragile
    Hac
    Heart Failure
    Home Visits
    Hospice
    Hospital Data
    Hospital Lists
    Hospital Strategies
    Incentives
    IQR
    Kidney
    Lawyers
    Life-expectancy
    Literacy
    Living Will
    Luxury
    Math
    Medical Devices
    Medicare Advantage
    Medicare Data
    Medicare Texts
    Medicare-texts
    Medpac
    Minorities
    Nursing Homes
    Odds
    Overview
    Pain
    Palliative Care
    Part C
    Patient Strategies
    Payments
    Penalties
    Penalty Percent
    Premiums
    Preparedness
    Prescriptions
    Prices
    Privacy Policy
    Public Comment
    Quality
    Readability
    Readmissions
    Reducing Costs
    Referral
    Representative
    Research
    Short Comments
    Sources
    Statistics
    Submissions
    Subsidies
    Telehealth
    Timing Of Penalties
    Tourism
    Vbp
    Waivers

    RSS Feed

Picture
  • HOME
  • Specialists
  • Medicare
  • Salt etc.
  • More