Division of Nephrology, Stanford University School of Medicine, 780 Welch Road, Palo Alto, CA 94304, USA.
Blood Purif. 2011;31(1-3):66-9. doi: 10.1159/000321856. Epub 2011 Jan 10.
The Centers for Medicaid and Medicare Services have announced a new Prospective Payment System to reimburse the care furnished by dialysis centers to patients with end-stage renal disease (ESRD). As of January 2011, most aspects of the outpatient treatment of patients with ESRD will be included in a single payment. In addition to the items previously included in the Composite Rate, injectable drugs and their oral equivalents will be included in this new capitation payment, as will the laboratory tests required for monitoring maintenance dialysis. As of January 2014, oral-only medications will also be included. Physician payments and payments for inpatient care, as well as for care not directly related to ESRD care will continue to be reimbursed separately. Patterns of medication treatment of ESRD patients will likely be revisited, and one can expect pronounced adjustments. Treatment of anemia will likely shift towards less use of erythropoiesis-stimulating agents and somewhat towards higher use of intravenous iron supplements. Average hemoglobin concentrations will decline. Use of intravenous vitamin D analogues will likely be reduced and substituted with their oral equivalents in many patients. One can also expect a temporary trend towards higher use of calcimetics, since their inclusion in the payment bundle is deferred until 2014. Treatment of problems with vascular access patency and of access infections will likely shift to the inpatient setting, and there may be reluctance to quickly accept recovering patients back to the outpatient setting after vascular access intervention. On aggregate, these changes have the potential to alter patient outcomes, but it is currently unclear how these will be and can be monitored.
美国联邦医疗保险和医疗补助服务中心宣布了一项新的前瞻性支付制度，以补偿透析中心为终末期肾病（ESRD）患者提供的护理。自 2011 年 1 月起，ESRD 患者的大部分门诊治疗将纳入单一支付。除了先前包含在综合费率中的项目外，注射药物及其口服等效物将包含在新的人头付费中，用于监测维持性透析的实验室检查也将包含在内。自 2014 年 1 月起，仅口服药物也将包含在内。医生支付以及住院护理和与 ESRD 护理无关的护理将继续单独报销。ESRD 患者的药物治疗模式可能会重新考虑，预计会有明显的调整。贫血的治疗可能会转向减少使用促红细胞生成素刺激剂，而转向更多使用静脉铁补充剂。平均血红蛋白浓度将会下降。静脉维生素 D 类似物的使用可能会减少，许多患者会用其口服等效物替代。由于它们被推迟到 2014 年才纳入支付方案，因此人们还预计钙调神经磷酸酶抑制剂的使用会暂时增加。血管通路通畅性和通路感染问题的治疗可能会转移到住院治疗，而且在血管通路干预后，可能不愿意迅速将康复患者转回门诊治疗。总体而言，这些变化有可能改变患者的预后，但目前尚不清楚这些变化将如何以及可以进行监测。
