By Bill Peckham
Yesterday RenalWEB linked to an article on MedPage Today that reports on a presentation at the ASN conference last week, ASN: Home Dialysis Gaining Momentum:
Home dialysis is becoming more common in the United States and is an important option to present to renal patients, researchers said here.
The number of home hemodialysis patients in the U.S. jumped by 35% between 2003 and 2007, from 1,787 to 3,374, Gary Inglese, RN, director of Renal Reimbursement for Baxter Healthcare Corporation, told attendees at the American Society of Nephrology meeting.
This is good news though the experience of Australia and New Zealand suggests the number could be a magnitude greater. Where the presentation looses me is in its financial analysis:
One of the forces behind this change is lower costs, said Inglese. The USRDS data shows a 35% lower annual cost for peritoneal dialysis, compared with in-center hemodialysis.
"The total annual healthcare costs for peritoneal dialysis in patients with end stage renal disease is about $53,000, compared with almost $72,000 for in-center hemodialysis," he said.
And two earlier studies have shown that home hemodialysis performed up to six times a week is generally between 10% and 20% less costly than thrice-weekly in-center dialysis, he added.
To say the cost are lower for peritoneal dialysis,
compared with in-center hemodialysis is wrong in the same way it is wrong to say the dialysis mortality rate is high. It's the cost of chronic kidney disease (CKD) that is lower when the CKD is treated with PD vs. conventional incenter hemodialysis (HD).
The lower CKD costs are seen on the Part A side of Medicare (the
hospital side). On the Part B side (the outpatient dialysis side) the
cost is the same regardless of dialysis modality (the cost to Medicare is 156 payments a year at a rate of approximately 80% of $150 +/- $15). This $18 to $20,000 a year in
payments from Medicare for dialysis doesn't change whether you are
doing PD or HD. Under most Medicare fiscal intermediaries the amount
does not change whether you dialyze three times a week using a HD
standard machine at home or six times a week using a new HD machine
designed just for home use - Medicare pays the same. To Medicare
dialysis is dialysis. Payment is modality neutral.
The savings to the system from someone using PD are real but they are not from the cost of providing the dialysis, the savings are largely from fewer and/or shorter hospitalizations. These same savings are available for anyone with stage 5 CKD. PD saves money on other CKD5 healthcare costs because it provides more dialysis than is provide by conventional incenter dialysis. When the data shows that hemodialysis performed up to six times a week is generally between 10% and 20% less costly than thrice-weekly in-center dialysis it is because people are avoiding expensive hospitalizations. Hemodialysis performed up to six times a week saves money on other CKD5 healthcare costs because it provides more dialysis than is provide by conventional incenter dialysis.The cost of the dialysis is the same while the cost to Medicare of providing medical care to someone with CKD5 is decreased.
What saved Medicare those CKD5 dollars? Dialysis. Dialysis saves money.
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