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Kidney Week

Abstract: PO1087

Medicare Reliance After Implementation of Medicare Payment Reform and the Affordable Care Act Marketplace

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Wang, Virginia, Duke Univ, Durham, North Carolina, United States
  • Hoffman, Abby, Duke Univ, Durham, North Carolina, United States
  • Hammill, Bradley G., Duke Univ, Durham, North Carolina, United States
  • Sloan, Caroline E., Duke Univ, Durham, North Carolina, United States
  • Maciejewski, Matthew L., Durham VAHCS, Durham, North Carolina, United States

Medicare finances health care for most US patients with ESKD, regardless of age. The 2011 Medicare bundled payment for dialysis reduced Medicare reimbursement for hemodialysis, increasing the difference between Medicare and private insurance that commonly reimburses dialysis providers at higher rates. Passage of the 2014 Affordable Care Act also increased patient access to new private insurance options. These policies may have influenced providers to adjust their payer mix, as dialysis facilities have reported increasing rates of patients not enrolled in Medicare since 2011. This study describes trends in Medicare enrollment among new ESKD patients in 2006-2016.


From the US Renal Data System, we identified a cohort of incident ESKD patients between 2006 and 2016. We identified each patient’s insurance status (Medicare, pending Medicare, non-Medicare) at dialysis initiation and observed changes over time. We report trends for the overall incident population, for patients aged 18-64, and by race.


The proportion of new ESKD patients enrolled in Medicare remained stable between 2006 (65%) and 2016 (67%). There was an increase in non-Medicare coverage (13.2% in 2006, 19% in 2016) and a reduction in pending Medicare applications (21% in 2006, 14% in 2016). These trends were more pronounced among patients aged 18-64 (i.e., not already in Medicare due to age) and among aged 18-64 non-Whites (Figure). Multivariable regression results are pending.


There was a modest shift in payer mix among new patients with ESKD after bundled payment reform in 2011 and private insurance expansion in 2014, with fewer patients applying for or enrolled in Medicare over time. To address concerns among policymakers about facilities encouraging private insurance coverage, future work should examine the implications of these trends on outcomes for patients.


  • NIDDK Support