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A population grows to depend on dialysis

by Diana Bradley, Staff Writer | November 17, 2011
From the November 2011 issue of HealthCare Business News magazine

“Hopefully the bundling will have little impact on our patients receiving the best quality of therapy they can,” says Kraus.

Patient Jim Smith dialyzes at an RV
stopwith the NxStage System One

Dialysis patient Jim Smith, 63, from Indianola, Wash., tells DOTmed News he has not personally been negatively impacted by the bundling.

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“The changes are invisible to patients; it’s tougher on dialysis centers — they get less money and still need to meet requirements,” he says.

This is one of the dialysis industry’s biggest reimbursement changes in decades, according to Jeff Burbank, CEO and founder of NxStage Medical Inc., adding that his company has not been affected.

“The net effect of the bundled payment structure was quite insignificant for us,” says Burbank. “We were very successful with transitioning through this reimbursement change.”

Treatment options
Dialysis treatment access has remained mostly unchanged over the past decade, according to CMS data. This may relate to the 70 percent of patients who do not seek proper education on available treatment options and begin dialysis without consulting a nephrologist, Kraus said.

“Most patients either feel they aren’t adequately trained or aware of the options,” says Kraus. “Physicians may not know how to prescribe the therapy, the availability of the therapy, or may not be willing to refer patients to a therapy they may or may not have in their own institution -- which may be best for the patient, but not best for a physician’s financial picture.”

From 1998 to 2010, at least 96 percent of facilities offered in-center hemodialysis and 46 percent offered peritoneal dialysis. Industry data suggest dialysis facilities are beginning to offer in-center nocturnal HD, including major provider DaVita, Inc., which operated over 115 nocturnal facilities in 2010. In addition, between 2003 and 2010, there was an increase from 12 to 22 percent in facilities offering home HD.

Dialyzing at home has recently gained popularity, shooting from 1,000 to 5,000 users in a short period of time. Because home dialysis treatments are more frequent and patients do not need to leave the house or use hospital space, it is more effective for health care systems and patients, says Kraus. Nearly 78 percent of ESRD patients are clinically and psychosocially eligible for peritoneal dialysis as a home dialysis therapy, according to a Nephrology Dialysis Transplantation study.

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