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Published ahead of print on August 5, 2007
J Am Soc Nephrol 18: 2565-2574, 2007
© 2007 American Society of Nephrology
doi: 10.1681/ASN.2006090949
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Clinical Epidemiology

Case-Mix Adjustment for an Expanded Renal Prospective Payment System

Richard A. Hirth, Marc N. Turenne, John R.C. Wheeler, Alyssa S. Pozniak, Philip Tedeschi, Chien-Chia Chuang, Qing Pan, Kathryn Slish and Joseph M. Messana

University of Michigan, Ann Arbor, Michigan

Correspondence: Prof. Richard A. Hirth, University of Michigan School of Public Health, Department of Health Management and Policy, 109 South Observatory, Ann Arbor, MI 48109-2029; Phone: 734-936-1306; Fax: 734-764-4338; E-mail: rhirth{at}umich.edu

Received for publication September 1, 2006. Accepted for publication April 17, 2007.

Medicare is considering an expansion of the bundle of dialysis-related services to be paid on a prospective basis. Exploratory models were developed to assess the potential limitations of case-mix adjustment for such an expansion. A broad set of patient characteristics explained 11.8% of the variation in Medicare allowable charges per dialysis session. Although adding recent hematocrit values or prior health care utilization to the model did increase explanatory power, it could also create adverse incentives. Projected gains or losses relative to prevailing fee-for-service payments, assuming no change in practice patterns, were significant for some individual providers. However, systematic gains or losses for different classes of providers were modest.


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J. Am. Soc. Nephrol. 2007 18: A12. [Full Text] [PDF]





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