Abstract: SA-PO975
Impact of National Payment Contracts on VA Spending and Access to Outpatient Community Dialysis
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Wang, Virginia, Durham VAHCS, Durham, North Carolina, United States
- Swaminathan, Shailender, Brown Univ, Providence, Rhode Island, United States
- Corneau, Emily A., Providence VAMC, Providence, Rhode Island, United States
- Maciejewski, Matthew L., Durham VAHCS, Durham, North Carolina, United States
- Trivedi, Amal, Brown Univ, Providence, Rhode Island, United States
- O'Hare, Ann M., VA Puget Sound HCS, Seattle, Washington, United States
- Mor, Vincent, Brown Univ, Providence, Rhode Island, United States
Background
End-stage kidney disease (ESKD) is common among Veterans. VA’s limited capacity to deliver dialysis care means that VA relies heavily on community providers, making chronic dialysis the largest VA expenditure for outpatient community care. In the past, VA paid for non-VA dialysis on a local, ad hoc basis, with some payments exceeding Medicare rates. In 2011 the VA began implementing payment policies to standardize the process of pricing non-VA dialysis care, including use of the Medicare fee schedule and national dialysis contracts. This study examined the effect of VA’s standardized pricing policies on VA costs and patient outcomes.
Methods
We used an interrupted time series design and 2006-2016 VA, Medicare, and the US Renal Data System data to identify Veterans receiving VA-financed dialysis in the community from non-VA providers. Changes in price over time for non-VA dialysis were ascertained from >7M VA-paid community dialysis claims. We performed multivariable regression analyses, using differential trend and intercept shift models, to examine the effects of VA pricing policies on: VA treatment prices for non-VA dialysis, access to non-VA dialysis care (number of non-VA dialysis facilities, patient distance to non-VA dialysis care), and 1-year mortality, controlling for patient and facility fixed effects.
Results
The cohort comprised 24,130 Veterans who received ≥1 VA-finaned community-based chronic dialysis treatment in 2006-2016. Before implementation of national contracts, treatment prices for non-VA dialysis care varied widely across VA facilities from $61 to $1,575 per treatment. After implementation of national contracts, there was much less variation in the cost of treatment across individuals ($73.40 to $663.37) and the average price per dialysis session dropped by 40% (p<0.001). Over the same time period, the average number of dialysis facilities providing VA-paid dialysis care grew from 19 to 37 and there were no changes in patient distance to non-VA dialysis facilities (p=0.81) or 1-year mortality (12% vs. 11%, p=0.98).
Conclusion
VA’s policy to standardize national dialysis contracts resulted in a substantial increase in the value of VA-financed community dialysis care by reducing spending with no adverse effect on Veterans’ access to care nor on mortality.
Funding
- Veterans Affairs Support