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Abstract: SA-PO707

Impact of Medicare Bundled Payment on Provision of Peritoneal Dialysis among Existing versus New Dialysis Providers

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis


  • Wang, Virginia, Duke Univ, Durham, North Carolina, United States
  • Coffman, Cynthia, Duke Univ, Durham, North Carolina, United States
  • Sanders, Linda L., Duke Univ, Durham, North Carolina, United States
  • Hirth, Richard A., U of Michigan, Ann Arbor, Michigan, United States
  • Lee, Shoou-Yih Daniel, UNC-Chapel Hill, Chapel Hill, North Carolina, United States
  • Maciejewski, Matthew L., Duke Univ, Durham, North Carolina, United States

One of the goals of Medicare's 2011 implementation of ESRD bundled payment is to encourage greater peritoneal dialysis (PD) provision among providers. Service strategies may differ between facilities operating prior to bundled payment proposals in 2005 versus new entrants in the dialysis market. We examine the differential response to dialysis payment reform on PD service availability among existing versus new dialysis providers.


We used the USRDS and Medicare data to construct a longitudinal cohort of US outpatient dialysis facilities in 2006-2013 and identified facilities operating before 2005 (existing) and opening after 2005 (new). Our outcome of interest was facility-level offering of PD service. We applied generalized estimating equations to examine whether the 2011 policy effect on PD services differed between existing and new facilities, adjusting for facility and regional ESRD and general demographic characteristics.


Of 6,194 dialysis facilities operating in 2006-2013, 70.5% were in operation before 2005 and 29.5% were new facilities. Over time PD provision modestly increased from 37% of facilities with PD in 2006 to 42% in 2013. Similar rates of existing and new facilities offered PD (38.6% vs. 39.8%), but there was a greater presence of new facilities exclusively offering home-based dialysis (1.9% of existing vs. 7.4% of new). In adjusted analysis, PD provision was greater after bundled payment (p<0.001), but there were no pre-post policy differences between existing and new facilities (p=0.67). PD services differed for new vs. existing by urban location: PD in existing facilities was similar but new, urban facilities offered PD at higher rates than new, non-urban facilities (p<0.001). Existing and new facilities differed in their relationship between facility size and PD provision, with a slower rate of PD provision by increasing facility size for new facilities (p=0.009).


Existing and relatively new entrants to the US dialysis market differ in their service strategies when it comes to PD services. However, existing and new dialysis providers responded similarly to the 2011 bundled payment reform.


  • NIDDK Support