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At least 19 recordsLinked to original sources
PubMed1988

Medicare program; End Stage Renal Disease Program; responsibilities of network organizations--HCFA. Final rule.

This final rule revises final regulations published on August 26, 1986 (51 FR 30356) pertaining to the End Stage Renal DIsease (ESRD) networks and organizations to reflect certain provisions of the ESRD program amendments contained in sections 9335 (d) through (h) of the Omnibus Budget Reconciliation Act of 1986. These regulations revise the responsibilities of network organizations.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1986

Medicare program; End Stage Renal Disease Program; redesignation of networks and reorganization of network organizations--HCFA. Final rule.

This final rule revises the requirements in current regulations pertaining to the End-Stage Renal Disease (ESRD) networks and organizations and establishes provisions for new, more efficient network organizations. This rule removes the criteria that define existing networks, removes the requirement that HCFA change designations of ESRD networks through rulemaking, and removes the list of currently-designated networks that now appears in regulations. It is intended that these amendments will increase the efficiency and effectiveness of the ESRD program by instituting a faster process for changing network designations and organizations as program needs arise. These amendments also permit the reduction of the number of existing networks to as few as 14, which is consistent with section 9214 of Pub. L. 99-272, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Effect of transplantation on the Medicare end-stage renal disease program.

The Medicare end-stage renal disease program has received considerable attention as a model of government funding for high-cost medical treatment. This paper examines how the program has been influenced by renal transplantation. In the past decade, the number of kidney transplantations has increased substantially, and the success rate of these procedures has improved. From 1980 to 1985, the number of transplantations increased by 10 percent per year. During that time, the survival rates for grafts from cadavers and living related donors increased by 7 and 3 percent, respectively, in part because of the introduction of cyclosporine. As a result, the fastest-growing group of beneficiaries of the Medicare end-stage renal disease program are those with functioning grafts. As of the end of 1985, these patients accounted for 18 percent of all beneficiaries and 32 percent of all beneficiaries less than 55 years of age. In the youngest groups, transplantation has reached a level sufficient to reduce the absolute numbers of patients on dialysis, beginning in 1983. Increases in transplantation are not evenly distributed among subgroups of beneficiaries. Relatively few patients 65 years of age and older receive transplants; blacks receive transplants at a rate roughly half that among whites, but the rate is increasing. Because the costs of maintaining patients with functioning grafts are only one third of those for patients on dialysis and because the quality of life is usually much better, renal transplantation is causing a convergence of the best clinical and economic outcomes for patients with end-stage renal disease.

Adolescent↗
PubMed1990

Mortality rates among dialysis patients in Medicare's End-Stage Renal Disease Program.

Medicare's End-Stage Renal Disease (ESRD) Program provides funding for life-saving renal replacement therapy for patients with irreversible chronic renal failure. Although more than 100,000 patients are currently alive due to dialysis and transplantation, mortality among ESRD patients is still much higher than in the general population. Gross mortality, calculated from aggregate statistics such as those available from the annual ESRD facility survey, is an extremely imprecise measure of mortality and can lead to misleading conclusions. Standard methods of survival calculation such as actuarial life-table analyses provide more accurate descriptions of variations and trends in mortality. The most important characteristic influencing mortality among ESRD patients on dialysis is the changing age and diagnostic distribution. The average age of dialysis patients has increased by over 5 years during the past decade. Patients whose renal failure is attributed to diabetic nephropathy currently account for 30% of all patients initiating renal replacement therapy each year and constitute the fastest growing group of ESRD patients. From 1982 to 1987, 1-year survival on dialysis was 72.7% for patients whose renal failure was attributed to diabetic nephropathy and 79.8% for all other patients. Survival decreases rapidly with advancing age at time of renal failure, from 95.1% among patients 15 to 24 years to 52.5% for patients over the age of 85 (for non-diabetics). Survival rates for whites are 5% to 6% lower than for other racial categories. There are no obvious trends in mortality among dialysis patients over the past decade. For patients whose renal failure is attributed to diabetic nephropathy, survival rates have remained constant despite overall aging in this group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Medicare programs; end-stage renal disease program; prospective reimbursement for dialysis services: Health Care Financing Administration. Proposed rule.

These proposed regulations would change the reimbursement system by which Medicare pays for outpatient dialysis and related physician and laboratory services. These changes would establish a prospective method of payment for maintenance dialysis, whether furnished at home or in a hospital-based or independent dialysis facility, and would revise other aspects of the reimbursement system to encourage home dialysis and provide incentives for economy and efficiency in furnishing these services. The amendments would implement section 2145 of the Omnibus Budget Reconcilation Act of 1981. We expect that these proposed changes will improve our administration of the end-stage renal disease program and enable us to control the rapidly growing costs of furnishing dialysis.

Hemodialysis, Home↗
PubMed1983

Medicare program; end-stage renal disease program; prospective reimbursement for dialysis services and approval of special purpose renal dialysis facilities--HCFA. Final rule.

These regulations change the reimbursement system by which Medicare pays for outpatient maintenance dialysis and related physician and laboratory services. These changes establish a prospective method of payment for maintenance dialysis, whether furnished at home or in a hospital-based or independent dialysis facility, and revise other aspects of the reimbursement system to encourage home dialysis and provide incentives for economy and efficiency in furnishing these services. These amendments implement section 2145 of the Omnibus Budget Reconciliation Act of 1981. We expect that these changes will improve our administration of the end-stage renal disease program and enable us to control the rapidly growing costs of furnishing dialysis. The controls on quality of care that have been in effect since the beginning of the program will continue to apply. These regulations will also ensure access to care by providing for adequate reimbursement to isolated, essential facilities, where patients have no alternative sources of dialysis care. These regulations also provide for time-limited approval for Medicare participation of special purpose renal dialysis facilities. As a general rule we have not approved facilities such as transient or mobile units set up for emergency purposes or to serve vacationing dialysis patients in State parks and children's camps. This change in regulations will remove this limitation.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1996

Quality of patient care in the Medicare End-Stage Renal Disease Program: the basis and implementation of the 1994-1997 End-Stage Renal Disease Health Care Quality Improvement Program.

Substantial changes have occurred in the quality assurance and improvement programs conducted by the Health Care Financing Administration in the Medicare End-Stage Renal Disease Program. This review is a brief description of these changes and an introduction to the health policy, epidemiology, health services research, clinical nephrology, and statistical process control literature that is the basis for this initiative.

Humans↗
PubMed1980

The impact of heroin abuse on a regional end-stage renal disease program.

The causes for end-stage renal disease (ESRD) in 148 consecutive patients 18-45 years of age were analyzed over a five-year period in the Buffalo-SMSA. Incidence, diagnostic category specific, prevalence, age patterns, and life expectancy are provided by sex, race, and heroin abuse status. A striking correlation between heroin abuse, glomerulonephritis, and ESRD among Blacks was discovered, demonstrating the impact of heroin abuse on both the cost and statistical interpretation of the causes for ESRD.

Adolescent↗
PubMed1985

Using end-stage renal disease facility surveys to monitor end-stage renal disease program trends. The Data Committee of the National Forum of End-Stage Renal Disease Networks.

Since 1982, the Forum of End-Stage Renal Disease Networks has used data from the Medicare End-Stage Renal Disease Facility surveys to track regional and national end-stage renal disease (ESRD) program trends. This article reports trends for selected program parameters during the years 1980 through 1983. Trends include an average annual increase of 11.1% in the number of chronic dialysis patients; a 78% rise in the number of home dialysis patients; a relatively constant percentage (7.2% to 7.7%) of dialysis patients receiving a transplant annually; and relatively stable dialysis patient mortality (annual case fatality rate, 14.9% to 15.4%). The utility of such data for quality assurance as well as program evaluation and planning is noted. The article also indicates how improved tracking of transplant recipients and organ procurement activity would strengthen the End-Stage Renal Disease Facility Survey data base.

Aged↗
PubMed1988

Patient selection in the Medicare End-Stage Renal Disease Program.

Since the inception of the Medicare End-Stage Renal Disease (ESRD) Program in 1972, the number of persons qualifying for this benefit has increased every year, even when controlling for growth of the US population. At the same time, the profile of the typical dialysis patient has changed dramatically over the years, with new enrollees tending to be older and sicker. This study attempts to explain case mix through an economic model of a dialysis provider who certifies eligibility of Medicare ESRD beneficiaries and manages their care. The model was tested using administrative data from the Medicare ESRD program and other sources. Results demonstrated that dialysis patient case mix is influenced by local area demand for medical care and factors such as competition or payment levels that might affect a provider's supply decisions.

Aged↗
PubMed1991

Validation of the cause of renal failure of patients in the Medicare end-stage renal disease program.

Studies addressing the epidemiological issues of end-stage renal disease (ESRD) and the implications for health resource allocations are valuable, especially because the Medicare ESRD program is expected to continue growing during the next decade. Studies on trends in the causes of renal failure have benefited from Medicare's extensive data files on ESRD patients. However, no studies have been published that validate the cause of renal failure field in the Medicare files. The primary disease causing renal failure for over 10,000 New York State patients in the Medicare ESRD program was compared with their hospital discharge diagnoses. Of these patients, 8,730 (83%) had a known cause of renal failure in the Health Care Financing Administration (HCFA) data files. Eighty-nine percent of these patients' primary cause of renal failure was matched with the same major hospital diagnostic code. Patients with diabetes and glomerulonephritis had the highest overall match rates (96% to 97%). Patients with polycystic kidney disease and causes of renal failure other than the four major causes had the lowest match rates (75% to 76%), but these match rates increased to 84% to 87% for patients hospitalized more than five times. Some differences in match rate by age and race were found. These findings suggest that HCFA data on the causes of renal failure of ESRD patients are reasonably accurate and can be used successfully to study a variety of issues related to the diseases leading to chronic renal failure.

Adult↗
PubMed1997

General health of end stage renal disease program beneficiaries.

A telephone survey of a national sample of 515 Medicare End Stage Renal Disease Program beneficiaries was conducted to obtain information on their health status and its determinants. The Medical Outcomes Study Short Form-36 (SF-36) was applied during the interview process to obtain the health-status information. The reliability of each SF-36 health-status dimension was at least 0.85, and the validity of seven of the eight dimensions was high. Weighted least-squares regression results showed that health-status levels were often lower among older patients and Hispanic persons, and sometimes lower for those with low incomes. The implications of using the SF-36 for health-status measurement are also described.

Activities of Daily Living↗
PubMed1990

Rationing of health care and the end-stage renal disease program.

The potential impact of rationing health care on the end-stage renal disease (ESRD) program is considered. The possible implications of the recommendations emanating from the study being conducted by the Institute of Medicine of the National Academy of Sciences are also mentioned. Particular emphasis is given to the potential consequences of rationing health care on the elderly and on certain socioeconomic groups with ESRD.

Advisory Committees↗
PubMedDate not supplied

Medicare's end-stage renal disease program: current status and future prospects.

The twenty-five years of the end-stage renal disease (ESRD) program have been characterized by remarkable clinical achievements, which have prolonged and improved the quality of life for thousands of patients. As the program enters the next millennium, it faces considerable challenges: As the number and acuity of patients increase, the availability of trained nephrologists will decrease, and total costs will continue to rise. Policymakers will need to work closely with the renal professional and patient communities to develop creative approaches to delivering and financing ESRD care that is of the highest quality, yet is affordable.

Capitation Fee↗
PubMed1980

A regional end-stage renal disease program: twelve years' experience.

As of 31 December 1978, 558 patients with end-stage renal disease had been treated with transplantation (150), home dialysis (109), and center dialysis (299). Three hundred twenty-eight patients survived--194 (59%) in center, 51 (15%) at home, and 83 (25%) with functioning grafts. The number and age of new patients continue to increase. Significantly more deaths occur among center dialysis patients than among transplant recipients or home patients. Cadaveric donors provide 71% of transplanted kidneys. The increase in new and older patients without a commensurate increase in cadaver organs results in a declining transplantation rate. Home dialysis training has not decreased. Home dialysis and transplantation can treat about 50% of all new patients. Equilibrium in the end-stage renal disease population will occur when 632 patients per million are receiving treatment. Of these, about 500 will be on center dialysis and will need about 100 stations per million population.

Cadaver↗
PubMed1994

The evolution of the end-stage renal disease program in Australia.

Australia was an early pioneer of national integrated programs for the management of end-stage renal disease (ESRD). From being a leader in numbers of patients per population treated, it is now in the top 15. The Australian program has a high proportion of living patients with functioning transplants and a high proportion of out-of-hospital dialysis. The proportion of elderly patients is increasing but lower than expected. A particular problem is the treatment of Aboriginal people. The ANZ Data surveys give accurate complete data for the national program. Unique features of the Australian patients are the high incidence of analgesic nephropathy and the low incidence of primary hypertension as a cause of renal failure. Surveys show that it is possible to improve transplantation rates 2 to 3 times. Analysis of Australian data raises the question of whether dialysis and transplantation should be offered to all potential patients regardless of comorbidity or quality of life when health resources are inevitably finite.

Adult↗
PubMed1987

The first DRG: lessons from the end stage renal disease program for the prospective payment system.

When Medicare implemented the diagnosis related group (DRG) method of reimbursement for hospitals in 1983, it already had a decade of experience using a prospective payment arrangement for its end stage renal disease (ESRD) program. We reviewed this experience to determine the lessons for Medicare's reimbursement of hospital services. The use of a fixed price for renal dialysis encouraged the introduction of cost-saving techniques. Failure to reduce the price for dialysis in keeping with the cost reductions, however, prevented the government from realizing the full benefits of prospective payment. In addition, there were important changes in medical practice that had independent effects on the program. Similar influences are likely to shape the impact of prospective payment on hospital behavior.

Diagnosis-Related Groups↗