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Abstract: TH-PO282

Medicare Payments for Ambulance Transport Between Skilled Nursing and Dialysis Facilities

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ray, Debabrata, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Kubisiak, Kristine, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

Most dialysis patients receiving care in a skilled nursing facility (SNF) undergo hemodialysis in off-site dialysis facilities and thus require transportation before and after each session. In specific circumstances, Medicare Part B provides coverage for ambulance transport between such facilities. However, Medicare payments to ambulance service providers have been scrutinized by the federal government. By year, we aimed to quantify trends in Medicare expenditures on ambulance transport between SNFs and dialysis facilities.

Methods

We analyzed data from the United States Renal Data System. We searched Medicare Part B claims in payment years 2011-2015 for ambulance transport and retained such claims with an origin/destination code pair that indicated transport between SNF and dialysis facility. We tallied the number of patients with ≥1 ambulance transport between SNF and dialysis facility, the cumulative number of patient-days with ambulance transport, and cumulative Medicare payments for ambulance transport.

Results

Ambulance transport utilization was similar in 2011 and 2012 and subsequently increased to an apex in 2014: 24,327 patients with ≥1 transport between SNF and dialysis facility and 783,786 patient-days with transport (32.2 days per patient). In 2015, utilization fell to 21,601 patients with ≥1 transport between SNF and dialysis facility and 643,808 patient-days with transport (29.8 days per patient). Cumulative Medicare payments for ambulance transport increased from $305.7 million in 2011 to $312.4 million in 2013; thereafter, payments fell to $285.4 million in 2014 and $235.3 million in 2015. In 2015, the Medicare payment rate for ambulance transport was $365 per patient-day, down from $411 per patient-day in 2012. As a share of all Medicare Parts A and B payments among beneficiaries with end-stage renal disease, cumulative Medicare payments for ambulance transport between SNFs and dialysis facilities fell from nearly 1.1% in 2011-2013 to 0.8% in 2015.

Conclusion

Medicare expenditures for ambulance transport between SNFs and dialysis facilities are falling, initially due to lower per-diem payments and later due to lower utilization. Nevertheless, even in 2015, the per-diem Medicare payment for ambulance transport remained more than 50% higher than the base-level Medicare payment ($239) for an outpatient hemodialysis session.

Funding

  • Commercial Support