Market Competition and Anemia Management in the United States Following Dialysis Payment Reform

Bibliographic Data

ID9096196
AuthorsAnshul Bhatnagar (0000-0002-8863-8089, Baylor College of Medicine, corresponding author), Vishnupriyadevi Parvathareddy (0000-0002-6338-836X, Baylor College of Medicine, corresponding author), Wolfgang C Winkelmayer (0000-0002-5272-425X, Baylor College of Medicine, corresponding author), Glenn M Chertow (0000-0002-7599-0534, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA), Kevin F Erickson (0000-0003-2164-609X, Baylor College of Medicine, corresponding author)
Year2023
Volume61
Issue11
Pages787-795
Publication date2023-11-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001924
PMID37721983
OpenAlexW4386825088
LanguageEN
References cited34

BACKGROUND: Whether market competition influences health care provider responses to national reimbursement reforms is unknown. OBJECTIVES: We examined whether changes in anemia management after the expansion of Medicare's dialysis payment bundle varied with market competition. RESEARCH DESIGN: With data from the US dialysis registry, we used a difference-in-differences (DID) design to estimate the independent associations of market competition with changes in anemia management after dialysis reimbursement reform. SUBJECTS: A total of 326,150 patients underwent in-center hemodialysis in 2009 and 2012, representing periods before and after reimbursement reform. MEASURES: Outcomes were erythropoiesis-stimulating agent (ESA) and intravenous iron dosage, the probability of hemoglobin <9 g/dL, hospitalizations, and mortality. We also examined serum ferritin concentration, an indicator of body iron stores. We used a dichotomous market competition index, with less competitive areas defined as effectively having <2 competing dialysis providers. RESULTS: Compared with areas with more competition, patients in less competitive areas had slightly more pronounced declines in ESA dose (60% vs. 57%) following reimbursement reform (DID estimate: -3%; 95% CI, -5% to -1%) and less pronounced declines in intravenous iron dose (-14% vs. -19%; DID estimate: 5%; 95% CI, 1%-9%). The likelihoods of hemoglobin <9 g/dL, hospitalization, and mortality did not vary with market competition. Serum ferritin concentrations in 2012 were 4% (95% CI, 3%-6%) higher in less competitive areas. CONCLUSIONS: After the expansion of Medicare's dialysis payment bundle, ESA use declined by more, and intravenous iron use declined by less in concentrated markets. More aggressive cost-reduction strategies may be implemented in less competitive markets

Anemia · Business · Competition (biology) · Dialysis · Economics · Intensive care medicine · Market competition · Market economy · Payment · Chronic Kidney Disease and Diabetes · Dialysis and Renal Disease Management · Erythropoietin and Anemia Treatment · Finance · Internal Medicine · Medicine

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