Association of the Comprehensive ESRD Care Model with Treatment Adherence.

Background: Poor adherence to scheduled dialysis treatments is common and can cause adverse clinical and economic outcomes. In 2015, the Centers for Medicare and Medicaid Innovation launched the Comprehensive ESRD Care (CEC) Model, a novel modification of the Accountable Care Organization framework. Many model participants reported efforts to increase dialysis adherence and promptly reschedule missed treatments.

COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis.

Importance: There is a need for studies to evaluate the risk factors for COVID-19 and mortality among the entire Medicare long-term dialysis population using Medicare claims data.

Objective: To identify risk factors associated with COVID-19 and mortality in Medicare patients undergoing long-term dialysis.

Design, Setting, And Participants: This retrospective, claims-based cohort study compared mortality trends of patients receiving long-term dialysis in 2020 with previous years (2013-2019) and fit Cox regression models to identify risk factors for contracting COVID-19 and postdiagnosis mortality.

Persistent Variation in Medicare Payment Authorization for Home Hemodialysis Treatments.

Objective: To analyze variation in medical care use attributable to Medicare's decentralized claims adjudication process as exemplified in home hemodialysis (HHD) therapy.

Data Sources/study Setting: Secondary data analysis using 2009-2012 paid Medicare claims for HHD and in-center hemodialysis (IHD).

Study Design: We compared variation across Medicare administrative contractors (MACs) in predicted paid treatments per standardized patient-month for HHD and IHD patients.

Factors Associated With Participation in a University Worksite Wellness Program.

Introduction: Healthcare reform legislation encourages employers to implement worksite wellness activities as a way to reduce rising employer healthcare costs. Strategies for increasing program participation is of interest to employers, though few studies characterizing participation exist in the literature. The University of Michigan conducted a 5-year evaluation of its worksite wellness program, MHealthy, in 2014.

Blood transfusion practices in dialysis patients in a dynamic regulatory environment.

Background: In 2011, Medicare implemented a prospective payment system (PPS) covering an expanded bundle of services that excluded blood transfusions. This led to concern about inappropriate substitution of transfusions for other anemia management methods.

Study Design: Medicare claims were used to calculate transfusion rates among dialysis patients pre- and post-PPS.

The initial impact of Medicare's new prospective payment system for kidney dialysis.

Background: Medicare implemented a new prospective payment system (PPS) on January 1, 2011. This PPS covers an expanded bundle of services, including services previously paid on a fee-for-service basis. The objectives of the new PPS include more efficient decisions about treatment service combinations and modality choice.

Using race as a case-mix adjustment factor in a renal dialysis payment system: potential and pitfalls.

Background: Racial disparities in health care are widespread in the United States. Identifying contributing factors may improve care for underserved minorities. To the extent that differential utilization of services, based on need or biological effect, contributes to outcome disparities, prospective payment systems may require inclusion of race to minimize these adverse effects.

When payment systems collide: the effect of hospitalization on anemia in renal dialysis patients.

Background: Different types of providers often face differing financial incentives for providing similar types of care. This may have implications for payment systems that target improvements in care requiring multiple types of providers.

Objectives: The objective of this study was to determine how hospitalization influences the anemia of Medicare patients with chronic renal failure, where anemia is treated under a prospective payment system during hospitalizations and under a fee-for-service system during outpatient renal dialysis.

Association of quarterly average achieved hematocrit with mortality in dialysis patients: a time-dependent comorbidity-adjusted model.

Background: Recent publications suggest that increased mortality is associated with high hematocrit targets in erythropoietin-stimulating agent-treated patients with chronic kidney disease. We aim to further inform the debate about optimal hematocrit targets, advancing the hypothesis that the current hematocrit target may not optimize the survival of patients with end-stage renal disease.

Study Design: Cross-sectional observational study.

Long-term outcomes of physician peer teaching.

Research conducted in 10 cities assessed long-term pediatric asthma outcomes from a peer teaching intervention for physicians to improve their asthma-related clinical and counseling skills. Hypotheses were better outcomes for patients, symptom reduction, less health care use, and enhanced view of the physician. Peers trained 53 intervention group pediatricians (seeing 418 patients); 48 pediatricians (seeing 452 patients) were controls.