Aaron J Trachtenberg1, Amity E Quinn1, Zhihai Ma1, Scott Klarenbach1, Brenda Hemmelgarn1, Marcello Tonelli1, Peter Faris1, Robert Weaver1, Flora Au1, Jianguo Zhang1, Braden Manns2. 1. Department of Internal Medicine (Trachtenberg), University of Manitoba, Winnipeg, Man.; Departments of Community Health Sciences (Quinn, Ma, Hemmelgarn, Tonelli, Faris, Weaver, Au, Zhang, Manns) and Medicine (Hemmelgarn, Tonelli, Manns), and Libin Cardiovascular Institute of Alberta and O'Brien Institute for Public Health (Hemmelgarn, Tonelli, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Alberta Health Services (Faris), Calgary, Alta. 2. Department of Internal Medicine (Trachtenberg), University of Manitoba, Winnipeg, Man.; Departments of Community Health Sciences (Quinn, Ma, Hemmelgarn, Tonelli, Faris, Weaver, Au, Zhang, Manns) and Medicine (Hemmelgarn, Tonelli, Manns), and Libin Cardiovascular Institute of Alberta and O'Brien Institute for Public Health (Hemmelgarn, Tonelli, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Alberta Health Services (Faris), Calgary, Alta. Braden.Manns@albertahealthservices.ca.
Abstract
BACKGROUND: Health care payers are interested in policy-level interventions to increase peritoneal dialysis use in end-stage renal disease. We examined whether increases in physician remuneration for peritoneal dialysis were associated with greater peritoneal dialysis use. METHODS: We studied a cohort of patients in Alberta who started long-term dialysis with at least 90 days of preceding nephrologist care between Jan. 1, 2001, and Dec. 31, 2014. We compared peritoneal dialysis use 90 days after dialysis initiation in patients cared for by fee-for-service nephrologists and those cared for by salaried nephrologists before and after weekly peritoneal dialysis remuneration increased from $0 to $32 (fee change 1, Apr. 1, 2002), $49 to $71 (fee change 2, Apr. 1, 2007), and $71 to $135 (fee change 3, Apr. 1, 2009). Remuneration for peritoneal dialysis remained less than hemodialysis until fee change 3. We performed a patient-level differences-in-differences logistic regression, adjusted for demographic characteristics and comorbidities, as well as an unadjusted interrupted time-series analysis of monthly outcome data. RESULTS: Our cohort included 4262 patients. There was no statistical evidence of a difference in the adjusted differences-indifferences estimator following fee change 1 (0.89, 95% confidence interval [CI] 0.44-1.81), 2 (1.15, 95% CI 0.73-1.83), or 3 (1.52, 95% CI 0.96-2.40). There was no significant difference in the immediate change or the trend over time in peritoneal dialysis use between fee-for-service and salaried groups following any of the fee changes in the interrupted time-series analysis. INTERPRETATION: We identified no statistical evidence of an increase in peritoneal dialysis use following increased fee-for-service remuneration for peritoneal dialysis. It remains unclear what role, if any, physician payment plays in selection of dialysis modality. Copyright 2020, Joule Inc. or its licensors.
BACKGROUND: Health care payers are interested in policy-level interventions to increase peritoneal dialysis use in end-stage renal disease. We examined whether increases in physician remuneration for peritoneal dialysis were associated with greater peritoneal dialysis use. METHODS: We studied a cohort of patients in Alberta who started long-term dialysis with at least 90 days of preceding nephrologist care between Jan. 1, 2001, and Dec. 31, 2014. We compared peritoneal dialysis use 90 days after dialysis initiation in patients cared for by fee-for-service nephrologists and those cared for by salaried nephrologists before and after weekly peritoneal dialysis remuneration increased from $0 to $32 (fee change 1, Apr. 1, 2002), $49 to $71 (fee change 2, Apr. 1, 2007), and $71 to $135 (fee change 3, Apr. 1, 2009). Remuneration for peritoneal dialysis remained less than hemodialysis until fee change 3. We performed a patient-level differences-in-differences logistic regression, adjusted for demographic characteristics and comorbidities, as well as an unadjusted interrupted time-series analysis of monthly outcome data. RESULTS: Our cohort included 4262 patients. There was no statistical evidence of a difference in the adjusted differences-indifferences estimator following fee change 1 (0.89, 95% confidence interval [CI] 0.44-1.81), 2 (1.15, 95% CI 0.73-1.83), or 3 (1.52, 95% CI 0.96-2.40). There was no significant difference in the immediate change or the trend over time in peritoneal dialysis use between fee-for-service and salaried groups following any of the fee changes in the interrupted time-series analysis. INTERPRETATION: We identified no statistical evidence of an increase in peritoneal dialysis use following increased fee-for-service remuneration for peritoneal dialysis. It remains unclear what role, if any, physician payment plays in selection of dialysis modality. Copyright 2020, Joule Inc. or its licensors.
Authors: Evelyn K Mentari; Peter B DeOreo; Andrew S O'Connor; Thomas E Love; Edmond S Ricanati; Ashwini R Sehgal Journal: Am J Kidney Dis Date: 2005-10 Impact factor: 8.860
Authors: Brenda R Hemmelgarn; Fiona Clement; Braden J Manns; Scott Klarenbach; Matthew T James; Pietro Ravani; Neesh Pannu; Sofia B Ahmed; Jennifer MacRae; Nairne Scott-Douglas; Kailash Jindal; Robert Quinn; Bruce F Culleton; Natasha Wiebe; Richard Krause; Laurel Thorlacius; Marcello Tonelli Journal: BMC Nephrol Date: 2009-10-19 Impact factor: 2.388
Authors: Amity E Quinn; Paul E Ronksley; Lauren Bresee; Flora Au; James Wick; Alexander A Leung; Kerry A McBrien; Braden J Manns; Reed F Beall Journal: CJC Open Date: 2021-01-20