Study compares first-year costs of HD and PD

[okarol]

Study compares first-year costs of HD and PD
8/13/2009 10:53:47 AM

Commercially-insured peritoneal dialysis patients will cost the payer less in the first year than patients who start on in-center hemodialysis, according to a new study.

The paper, "Peritoneal dialysis versus hemodialysis in patients with end‐stage renal disease: A comparison of health care utilization and cost," was published this week in the American Journal of Managed Care.

Using the PharMetrics Patient‐Centric Database, a 14 million member claims database from over 85 U.S. health plans, the authors identified PD and in-center HD patients who began dialysis between January 1, 2004 and December 31, 2006. A total of 463 patients met all study criteria; 56 (12%) began treatment with PD and 407 (88%) with in-center HD. Fifty PD patients could be propensity‐matched to an equal number of HD patients.

The results showed that HD patients were more than twice as likely as matched PD patients to be hospitalized during follow‐up. Their median health care costs over the 12‐month follow‐up period were $43,510 higher ($173,507 vs $129,997 for PD).

The authors acknowledged that on average, PD patients in the study were younger than the HD group. Fewer of the PD patients had a history of congestive heart failure; more had renal osteodystrophy. Health care costs during pre-ESRD treatment were slightly higher among PD patients.

In the absence of head‐to‐head clinical trials, which may never be conducted, observational studies such as ours may be the only means of comparing health care utilization and costs in patients beginning dialysis with HD versus PD, the authors wrote.

The study was funded by Baxter Healthcare Corporation.

http://www.nephronline.com/features.asp?F_ID=459

[willowtreewren]

And now could we see a study of home hemo vs. PD?

Baxter would not be funding that one! 

 

[petey]

I can compare in-center hemo to home hemo.  These figures are from my EOB (Explanation of Benefits) from my insurance company (Marvin is Medicare and then I also carry him on my private insurance -- Blue Cross/Blue Shield -- this is secondary for him).

In-center treatments -- my insurance was billed $750 per treatment (3 x week)
Home hemo (in my home, with no "overhead" for the clinic, no salaries for nurses/techs, no light bills, no water bills, etc.) -- my insurance is billed $1,541 per treatment (5 x week)

Is there anyone who can explain this to me so that I can understand it?

[tyefly]

wow....  That is a big difference......   at that price  you would think that they would not want us to do home hemo.....  too costly..... thats scary.....   Iam planning on doing homehemo when I go on dialysis and I didnt realize how much that would cost.....       its like almost three times more......  how can that be...... with no over head...

[Zach]

There's a difference between what is charged and what is paid.

Please see the example below, from my Medicare EOB for in center hemodialysis.  While it is from 2006, the facts remain the same.

For the month of September 2006, the total amount charged was $16,240.06.  And then there is a Note "p" on the upper right side.

If you look at the Notes Section, under Section "p" the amount Medicare paid for the entire month of September was $2,059.15 (which is 80% of the total payment) including medications.  Secondary insurance (Medigap) pays the remaining 20% -- in this case $516.42.

[Jie]

Charges to private insurance and medicare are two different things. As Zach shows here that medicare paid 20% of the charges, not enough to cover even the medical supplies, let alone the salary and profits of the clinic. Private insurances have to make up the shortfall from medicare; this explains why some clinics charge huge prices to private insurances.

My clinic has about 80-90 PD patients. The money they make from me (private insurance) alone should be able to cover 1/4 of their salary and benefits.  If every PD patients pay as much as me, every worker in the clinic would make a million $ a year. However, more than 90% of patients are with medicare, which hardly pay enough for medical supplies. 

[petey]

There's a difference between what is charged and what is paid.

Notice I said in my post that this is what my insurance company was billed -- not what it paid.  The figures I quoted were from my BCBS EOB (after Medicare had been billed).

I just don't understand why they can BILL over twice as much for a home hemo treatment as they do for one in-center.  And, I realize (as I was told many, many years ago by a dialysis clinic supervisor) that those patients with private insurance (though they are few in number) are the ones who make the dialysis business a profitable one.  But, Marvin has always had a secondary, private pay insurance -- even when he was in-center.

You don't even want to get me started about my medicine plan and its co-pay.

All I'll say is somebody is making a helluva lot of $$$ off Marvin's disease and his treatments -- and it's not us!