Payment reforms reduce dialysis costs for veterans and improve access to care
A series of payment reforms implemented by the U.S. Department of Veterans Affairs for veterans with end-stage kidney disease were found to reduce costs for dialysis sessions.
These reforms also led to improved access to treatments without any notable changes in care quality, according to the researchers.
“Because of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers,” Virginia Wang, PhD, of the Durham Veterans Administration Health Care System and Duke University School of Medicine, and colleagues wrote. “Prior to 2011 — when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care — payments to community providers were largely unregulated.”
In a related press release, Wang elaborated on the reasoning behind the study.
“Our goal was to describe the impact of policies to centralize and standardize the way in which dialysis services are purchased by the VA,” she said.
For the study, Wang and colleagues included veterans who received VA-financed dialysis in community-based dialysis facilities. Investigators assessed costs of treatments and access to care before (2006 to 2008), during (2009 to 2010) and after the enactment of VA policies to standardize dialysis payments (2011 to 2016).
“We found that there were marked reductions in the average payments for dialysis and the variability of these payments without any adverse unintended consequences,” Wang said.
More specifically, the researchers noted the unadjusted average per-treatment reimbursement for non-VA dialysis care varied widely before payment reform ($47 to $1,575).
After payment reform, they observed a 44% reduction ($44 to $250) in the adjusted price per dialysis session, as well as less variation in payments for dialysis ($73 to $663).
In addition, they determined there was an increase in the number of community dialysis facilities contracting with the VA to deliver care (from 19 to 37 facilities per VA hospital). Regarding care quality and adverse outcomes, the researchers observed no changes in the quality of community dialysis facilities or in 1-year mortality rates.
“In the context of VA’s increasing reliance on community care for a growing number of services, these findings support the feasibility of implementing payment strategies that lower costs without jeopardizing VA partnerships with community providers or compromising access to care or clinical outcomes,” Wang and colleagues concluded of the findings.
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