Virginia Wang1,2,3, Shailender Swaminathan4,5, Emily A Corneau4, Matthew L Maciejewski6,2,3, Amal N Trivedi4,5, Ann M O'Hare7,8, Vincent Mor4,5. 1. Center of Innovation for Health Services Research, Durham Veterans Affairs Health Care System, Durham, North Carolina virginia.wang@va.gov. 2. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina. 3. Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina. 4. Center of Innovation for Long Term Services and Supports, Providence Veterans Affairs Health Care System, Providence, Rhode Island. 5. Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island. 6. Center of Innovation for Health Services Research, Durham Veterans Affairs Health Care System, Durham, North Carolina. 7. Center for Health Services Research in Older Adults, Puget Sound Health Care System, Seattle, Washington. 8. Department of Medicine, University of Washington, Seattle, Washington.
Abstract
BACKGROUND AND OBJECTIVES: Because of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011-when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care-payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans' access to dialysis care and mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An interrupted time series design and VA, Medicare, and US Renal Data System data were used to identify veterans who received VA-financed dialysis in community-based dialysis facilities before (2006-2008), during (2009-2010), and after the enactment of VA policies to standardize dialysis payments (2011-2016). We used multivariable, differential trend/intercept shift regression models to examine trends in average reimbursement for community-based dialysis, access to quality care (veterans' distance to community dialysis, number of community dialysis providers, and dialysis facility quality indicators), and 1-year mortality over this time period. RESULTS: Before payment reform, the unadjusted average per-treatment reimbursement for non-VA dialysis care varied widely ($47-$1575). After payment reform, there was a 44% reduction ($44-$250) in the adjusted price per dialysis session (P<0.001) and less variation in payments for dialysis ($73-$663). Over the same time period, there was an increase in the number of community dialysis facilities contracting with VA to deliver care to veterans with ESKD from 19 to 37 facilities (per VA hospital), and there were no changes in either the quality of community dialysis facilities or crude 1-year mortality rate of veterans (12% versus 11%). CONCLUSIONS: VA policies to standardize payment and establish national dialysis contracts increased the value of VA-financed community dialysis care by reducing reimbursement without compromising access to care or survival.
BACKGROUND AND OBJECTIVES: Because of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011-when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care-payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans' access to dialysis care and mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An interrupted time series design and VA, Medicare, and US Renal Data System data were used to identify veterans who received VA-financed dialysis in community-based dialysis facilities before (2006-2008), during (2009-2010), and after the enactment of VA policies to standardize dialysis payments (2011-2016). We used multivariable, differential trend/intercept shift regression models to examine trends in average reimbursement for community-based dialysis, access to quality care (veterans' distance to community dialysis, number of community dialysis providers, and dialysis facility quality indicators), and 1-year mortality over this time period. RESULTS: Before payment reform, the unadjusted average per-treatment reimbursement for non-VA dialysis care varied widely ($47-$1575). After payment reform, there was a 44% reduction ($44-$250) in the adjusted price per dialysis session (P<0.001) and less variation in payments for dialysis ($73-$663). Over the same time period, there was an increase in the number of community dialysis facilities contracting with VA to deliver care to veterans with ESKD from 19 to 37 facilities (per VA hospital), and there were no changes in either the quality of community dialysis facilities or crude 1-year mortality rate of veterans (12% versus 11%). CONCLUSIONS: VA policies to standardize payment and establish national dialysis contracts increased the value of VA-financed community dialysis care by reducing reimbursement without compromising access to care or survival.
Authors: Virginia Wang; Cynthia J Coffman; Karen M Stechuchak; Theodore S Z Berkowitz; Paul L Hebert; David Edelman; Ann M O'Hare; Susan T Crowley; Hollis J Weidenbacher; Matthew L Maciejewski Journal: J Am Soc Nephrol Date: 2018-12-07 Impact factor: 10.121
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Authors: Amy M Kilbourne; Nancy E Morden; Karen Austin; Mark Ilgen; John F McCarthy; Gregory Dalack; Frederic C Blow Journal: Gen Hosp Psychiatry Date: 2009-08-27 Impact factor: 3.238
Authors: Kate H Magid; Emily Galenbeck; Leah M Haverhals; Portia Y Cornell; Patience Moyo; Amy L Mochel; Emily Corneau; James L Rudolph; Vincent Mor; Cari Levy Journal: J Am Med Dir Assoc Date: 2022-04-14 Impact factor: 7.802
Authors: Virginia Wang; Lindsay Zepel; Bradley G Hammill; Abby Hoffman; Caroline E Sloan; Matthew L Maciejewski Journal: JAMA Netw Open Date: 2022-09-01