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Are the incentives in the ESRD payment bundle getting more dialysis patients home?

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Each year, Nephrology News & Issues collects data on patient census from the largest dialysis providers in the United States. The 19th annual survey, appearing in NN&I’s upcoming July issue, includes information on in-center as well as home dialysis patients.

In 2012-2013, most providers increased the number of patients on home dialysis. Fresenius Medical Care, for example, the largest dialysis provider in the United States, increased its home patient population (home hemodialysis and peritoneal dialysis) to 15,434 patients. That represents a jump of more than 5,000 patients from 2011 to 2013 (10,812 vs. 15,434), and an increase from 7.9% of their total patient population in 2011 to 9.4% in 2013 – a 1.5% positive change in two years. The company’s home dialysis population census was aided by a merger with Liberty Dialysis in 2011-2012 that added 1,400 home patients to FMC’s home dialysis patients census.

FMC’s peritoneal dialysis population grew from 10,114 in 2011 to 12,188 in 2012, and then 13,242 in 2013. The home hemodialysis population grew from a lowly 698 in 2011 to 1,922 (after the Liberty merger) to 2,192 in 2013.

DaVita, the country’s second largest dialysis provider, also saw a substantial leap in home dialysis patients. The company, which has expanded overseas over the last two years, had 11,500 peritoneal dialysis patients in 2011, 13,800 in 2012, and 15,700 in 2013. That represents a 4,200-patient increase in two years. In contrast, DaVita increased its home hemodialysis patient population by only 580 patients -- from 2,220 in 2011 to 2,800 in 2013.

The increases in the home dialysis population may be the result of changes in the Prospective Payment System, or the ESRD bundle, launched for dialysis care in 2011. That new bundled payment model includes financial incentives when dialysis providers and nephrologists place patients on home dialysis.

Have the incentives made a big enough impact to send people home? More time is needed to see if this growing presence for home dialysis can be sustained. -by Mark Neumann

Look for all of the results from our annual survey in the July issue of NN&I.