Dialysis composite rate bundling: potential effects on the utilization of home hemodialysis, daily and nocturnal hemodialysis, and peritoneal dialysis.

Home hemodialysis was introduced because it was less expensive than center dialysis, so allowing more patients to be treated with the limited funds available in the 1960s. The start of the Medicare ESRD Program in July 1973, with almost universal entitlement, removed the financial barriers, and had many other effects including reducing the use of home dialysis. Bundled payment for dialysis, including necessary dialysis supplies and laboratory tests, was introduced as the "composite" rate in 1983. Over the ensuing years, the costs of providing dialysis treatment increased, and expensive new drugs were introduced, particularly erythropoietin. As a result, the government introduced a more extensive bundle at the beginning of this year, aimed at better control of costs. This article considers the potential effect of this reimbursement change on home dialysis.