Nonresident Scholar
Department of Medicine, Selzman Institute for Kidney Health, Section of Nephrology
Approximately 25% of patients initiating dialysis in the United States are covered by state Medicaid programs, and Medicare covers 65% of all prevalent patients receiving dialysis, presenting significant challenges for federal and state budgets. In an effort to contain costs without compromising the quality of dialysis care delivered, public payers tightly regulate the provision of dialysis care. Federal mandates, in particular, have affected nearly all areas of dialysis care delivery. Yet, the evidence supporting federal mandates varies, contributing to differences in the achievement of stated policy objectives.
A recent perspective outlined key features to consider when assessing the evidence supporting policy mandates, including: (1) clearly defining the policy of interest, (2) evaluating policy within the context of specific goal(s), and (3) assessment of the magnitude of the policy’s effect on the stated goal(s). We apply these principles to evaluate the evidence behind two prior federal mandates affecting the care of patients with ESRD receiving hemodialysis: reform of the Monthly Capitation Payment (MCP) for nephrologists providing outpatient dialysis care in 2004, and inclusion of injectable medications into the ESRD composite rate payment to dialysis facilities in 2011. More than 20 years of combined follow-up since these policies were enacted provide sufficient time to assess how the quality of evidence supporting each policy contributed to its overall success.
Read the full article in Journal of the American Society of Nephrology.
