As The Dialysis Bundled Payment Plan Draws Near, Medical Directors and Renal Administrators Become More Concerned About Negative Patient Outcomes In ESRD
EXTON, Pa., March 24 BioTrends announces the release of the second wave of an on-going series of reports, Special Report: Impact of the Dialysis Bundled Payment System. The Centers for Medicare and Medicaid Services will be implementing the new payment system on January 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 - the current system includes a payment for services and an add-on for injectable products administered during dialysis treatments.
BioTrends surveyed 150 medical directors and 100 renal administrators across dialysis facilities in the U.S. In addition, interviews were conducted with key stakeholders (renal organizations, dialysis company executives, key opinion leaders and commercial payors). 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.
Compared to the baseline wave (conducted in June 2009), medical directors report a significantly higher awareness of the ESRD bundle and have become decidedly more negative about the impact to patient outcomes. Close to three-quarters of the respondents now expect bundling to have a "negative" impact on patient outcomes, compared to 43% in June. 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.
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.
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