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Kidney Week

Abstract: SA-PO1081

The Ambiguous Identity of Home Hemodialysis in Medicare Claims

Session Information

  • Home Hemodialysis
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Hemodialysis

Authors

  • Weinhandl, Eric D., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Kubisiak, Kristine, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Collins, Allan J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

Home hemodialysis (HHD) is performed in a home, which may be a private residence or a skilled nursing facility (SNF). Although the Centers for Medicare & Medicaid Services issued a condition code in 2005 for dialysis in a SNF, the code is rarely used. Epidemiologic and actuarial analysis of HHD in Medicare claims is thus compromised by an uncertain mix of two very different care settings. We analyzed Medicare expenditures among contemporary HHD patients, stratified by probable status of the HHD program as a SNF-oriented provider.

Methods

Using 2016 Medicare Limited Data Sets, including 100% of institutional claims and 5% of physician/supplier claims, we tallied Medicare Parts A and B expenditures, excluding those for outpatient dialysis, for HHD patients. We used public use files to remove wage indices from all expenditures. We stratified patients according to one facility-level factor: the percentage of patients in the facility on December 31, 2015, who had resided in a SNF during any part of 2015, as shown in the Dialysis Facility Report. For simplicity, we stratified HHD patients according to whether this facility-level factor was <40% versus ≥40%. Within each stratum, we calculated expenditures per patient-year (PY).

Results

Total Medicare Parts A and B expenditures, excluding those for dialysis, were $52,678 and $191,242 per PY among HHD patients in facilities with <40% and ≥40% prior-year prevalence of SNF residency. This factor was associated with large relative rates in inpatient facility, skilled nursing facility, and ambulance transport expenditures, as shown in the table. Analysis of individual facilities with HHD patients and the highest values of prior-year prevalence of SNF residency routinely revealed providers that deliver on-site hemodialysis in the SNF setting.

Conclusion

HHD in Medicare claims clearly reflects two phenotypes. CMS must address this inherent ambiguity to facilitate meaningful evaluation of outcomes on HHD.