Market Competition and Anemia Management in the United States Following Dialysis Payment Reform.
Med Care
; 61(11): 787-795, 2023 Nov 01.
Article
in En
| MEDLINE
| ID: mdl-37721983
ABSTRACT
BACKGROUND:
Whether market competition influences health care provider responses to national reimbursement reforms is unknown.OBJECTIVES:
We examined whether changes in anemia management after the expansion of Medicare's dialysis payment bundle varied with market competition. RESEARCHDESIGN:
With data from the US dialysis registry, we used a difference-in-differences (DID) design to estimate the independent associations of market competition with changes in anemia management after dialysis reimbursement reform.SUBJECTS:
A total of 326,150 patients underwent in-center hemodialysis in 2009 and 2012, representing periods before and after reimbursement reform.MEASURES:
Outcomes were erythropoiesis-stimulating agent (ESA) and intravenous iron dosage, the probability of hemoglobin <9 g/dL, hospitalizations, and mortality. We also examined serum ferritin concentration, an indicator of body iron stores. We used a dichotomous market competition index, with less competitive areas defined as effectively having <2 competing dialysis providers.RESULTS:
Compared with areas with more competition, patients in less competitive areas had slightly more pronounced declines in ESA dose (60% vs. 57%) following reimbursement reform (DID estimate -3%; 95% CI, -5% to -1%) and less pronounced declines in intravenous iron dose (-14% vs. -19%; DID estimate 5%; 95% CI, 1%-9%). The likelihoods of hemoglobin <9 g/dL, hospitalization, and mortality did not vary with market competition. Serum ferritin concentrations in 2012 were 4% (95% CI, 3%-6%) higher in less competitive areas.CONCLUSIONS:
After the expansion of Medicare's dialysis payment bundle, ESA use declined by more, and intravenous iron use declined by less in concentrated markets. More aggressive cost-reduction strategies may be implemented in less competitive markets.
Full text:
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Collection:
01-internacional
Database:
MEDLINE
Language:
En
Journal:
Med Care
Year:
2023
Document type:
Article