‘Cherry Picking’ Patients Common in Dialysis Clinics04/03/2009
STANFORD, Calif.—“Cherry picking” is a common strategy used to attract healthier, better insured and more adherent dialysis patients to clinics, according to a study published online April 1 in the Clinical Journal of the American Society of Nephrology.
“Under current reimbursement practices, dialysis caregivers perceive that cherry picking is common and important,” the researchers wrote. “An improved understanding of cherry picking practices, if evident, may help to protect vulnerable patients if reimbursement practices were to change.”
A new payment bundle for dialysis will be implemented in 2011. It will include services in the current composite rate, separately billable drugs, and lab tests that are not part of the composite rate.
To better understand the practice of cherry picking, researchers conducted a national survey to measure what people believe drives quality dialysis. The respondents were asked about their perception of cherry picking, as well as the frequency and effect of its strategies on dialysis outcomes.
The national survey included a random sample of 250 nurses from the American Nephrology Nurses Association, 250 nephrologists from the American Medical Association, 50 key opinion leaders, and 2,000 physicians from the Renal Physicians Association.
The researchers said they tested hypothesized predictors of perception, which included provider group, region, age, experience, and the main practice facility features. They found that three-quarters of those surveyed reported that cherry picking happened “sometimes” or “frequently.”
There were no differences in perceptions by provider or facility characteristics, insurance status, or health status, according to the study. In addition, perceived cherry picking was higher in the northeast and Midwest than in the western United States.
The cherry picking strategies with the largest perceived association with outcomes included a “low threshold to ‘fire’ chronic no-shows/late arrivers," and having a "low threshold to 'fire’ for noncompliance with diet and meds,” according to the study.
The researchers concluded that, “An improved understanding of cherry picking practices, if evident, may help to protect vulnerable patients if reimbursement practices were to change,” such as a new payment bundle.
* Sources: Clinical Journal of the American Society of Nephrology: Is there "Cherry Picking" in the ESRD Program? Perceptions from a Dialysis Provider Survey
http://cjasn.asnjournals.org/cgi/content/abstract/CJN.05661108v1http://www.renalbusiness.com/hotnews/cherry-picking-common-dialysis-clinics.html
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