Table 1 Summary of the studies included in the review
From: Payment systems for dialysis and their effects: a scoping review
ID (year) | Country | Study subject | Study outcomes | Main results |
|---|---|---|---|---|
Chang (2014) [23] | Taiwan | change from FFSa to ODBGb | outpatient visits, medication use, access to dialysis services, bundle of services doctors were providing | “Access to dialysis services” and the number of “dialysis visits” was not affected. The bundle of services provided to dialysis patients during their dialysis visit was changed. The cost of antihypertensive drugs during the “dialysis visit” reduced, which increased “non-dialysis visits” with the prescription of antihypertensive drugs. |
Trachtenberg (2020) [24] | Alberta (Canada) | increases in physician remuneration for PDc | PD use (90 days after dialysis initiation) | There was no statistical evidence of an increase in PD use. |
Wang (2016) [25] | USA | the 2011 PPSd, and the FDA change in ESA labels | Major adverse cardiovascular events (MACEs), hospitalized congestive heart failure (H-CHF), venous thromboembolism, transfusions | The risks of MACE and death did not change; the risk of stroke reduced, and the rate of transfusions increased. |
Spoendlin (2018) [26] | USA | the 2011 PPS | IVe vitamin D use | totally implementation of PPS associated with reduction in IV vitamin D use |
Hasegawa (2011) [27] | Japan | rHuEPO bundled reimbursement policy | Hgbf levels, rHuEPO use, IV iron use | This policy was associated with reduced rHuEPO doses, increased IV iron use, and stable Hgb levels. |
Mentari (2005) [16] | USA | the 2004 reformg | Visits, HRQoLh, quality of care (Kt/Vi, albumin level, Hgb level, phosphorus level, calcium level, hemodialysis catheter use, ultrafiltration volume, shortened or skipped treatments, hospital admissions, hospitalization days) | Visits increased. There were no important changes in Kt/V, levels of albumin, Hgb, phosphorus, calcium, and HDj catheter use, ultrafiltration volume, shortened or skipped treatments, hospital admissions, hospitalization days, or HRQoL, including patient satisfaction. |
Brunelli (2013) [28] | USA | the 2011 PPS | PD use, medication use, Hgb level, PTHk level, transfusion rates | Use of cinacalcet, phosphate binders, and oral vitamin D increased. IV vitamin D decreased. ESA use decreased. PTH levels increased. Hgb level decreased. PD increased. Transfusion increased. |
Chang (2011) [29] | Taiwan | ODBG | outpatient/inpatient/emergency room utilization by the ESRD patients | outpatient utilization by the ESRD patients increased. No change in emergency room and inpatient utilization occurred. |
Erickson (2016) [30] | USA | the 2004 reform | home dialysis | Home dialysis reduced, especially in larger dialysis facilities compared to smaller facilities. |
Haarsager (2017) [31] | Queensland (Australia) | The Queensland’s incentive paymentsl | PD as first modality, AVF/AVGm rate at first HD | commencement of dialysis with PD or an AVF/AVG in 2011–12, when pay-for-performance applied, didn’t change. It improved in the subsequent 2 years, which may be due to a lag effect. |
Erickson (2017) [32] | USA | the 2004 reform | hospitalizations, rehospitalizations | All-cause hospitalization or rehospitalization didn’t change, but slight reductions occurred in fluid overload hospitalization and rehospitalization. |
Erickson (2014) [9] | USA | the 2004 reform | visit, mortality, transplant waiting list, costs | Dialysis visits and Medicare costs increased with no evidence of a benefit on survival or kidney transplant listing. |
Zhang (2017) [33] | USA | the 2011 PPS | PD use | PD usage increased. Small dialysis organizations and nonprofit organizations appeared to increase use of PD faster compared to large dialysis organizations and for-profit units. |
Hirth (2013) [12] | USA | the 2011 PPS | medication use, PD use, cost | Less expensive medications were substituted for more expensive types (e.g., vitamin D products, EPO use reduced, iron products increased). Drug spending overall decreased. PD usage increased. |
Desai (2009) [34] | USA | the 2011 PPS | Perceived frequency and effect of cherry picking | Three-quarters of respondents reported that cherry picking occurred “sometimes” or “frequently.” All cherry-picking practices caused moderate to large effects on outcomes. |
Wang (2018) [35] | USA | the 2011 PPS | facility provision of PD | PD provision increased. |
Young (2019) [36] | USA | the 2011 PPS | discontinuation of PD, death | The risk of PD discontinuation fell. No adverse effect on mortality. |
Sloan (2019) [37] | USA | the 2011 PPS | modality switches, PD use | PD usage increased. PD-to-HD switches decreased, HD-to-PD switches increased. |
Norouzi (2020) [38] | USA | the 2011 PPS | dialysis facility closures | The PPS was not associated with increased closure of dialysis facilities. |
Kleophas (2013) [39] | Germany | weekly flat rate payments and Quality Assurance (QA) system | four quality parameters (Treatment time, spKt/V, dialysis frequency, and Hgb) | Short treatment times (less than 4 h) and low Kt/V (below 1.2) reduced after implementation of QA. The frequency of prescribed HD sessions < 3 per week remained low. Hgb levels improved. |
Spiegel (2010) [40] | USA | several recent eventsn | Hgb level | Hgb > 12 decreased and Hgb < 10 increased (mean Hgb level decreased), while target level is 10 < Hgb < 12 |
Monda (2015) [41] | USA | the 2011 PPS | ESA use, medication use, laboratory parameters, hospitalization events, and mortality | EPO use and mean Hgb level reduced. |
Swaminathan (2015) [10] | USA | the 2011 PPS | ESA use | Use of ESAs reduced in patients who may not benefit from these agents. |
Wetmore (2016) [42] | USA | the 2011 PPS | RBC transfusions, Medicare-incurred costs, sites of anemia management | transfusion increased. Site of care for transfusions have shifted to emergency departments or during observation stays. EPO dose declined. IV iron use decreased. a partial shift occurred in the cost and site of care for anemia management from dialysis facilities to hospitals |
Fuller (2016) [11] | USA | the 2011 PPS | ESA use, IV iron use, Hgb level | From 2010 to 2013, substantial declines in ESA use and Hgb levels occurred in the United States but not in other DOPPS countries. Iv iron doses in the United States remained fairly stable. |
Pirkle (2014) [43] | USA | the 2011 PPS | Hgb level, compliance | Hgb levels were stable over the 5 quarters of the study. Patient compliance with attendance for all scheduled home training unit visits was 84% (high). |
Lin (2017) [44] | USA | the 2011 PPS | home dialysis use | Home dialysis increased, in both Medicare and non-Medicare patients. The training add-on did not associate with increases in home dialysis use. |
McFarlane (2010) [45] | 12 DOPPS countrieso | ESA and Hgb trends before 2007 CMS policy | Hgb level, ESA use | ESA usage rose except in Belgium. Hgb levels increased except in Sweden. These trends are independent of the reimbursement. But in the United States financial incentives increased use of these agents. |
Thamer (2015) [46] | USA | the 2011 PPS | EPO use, hematocrit level | EPO usage, dosing and achieved hematocrit levels were declined after PPS. |
Mendelssohn (2004) [47] | Ontario (Canada) | the capitation fee in 1998 | dialysis modality rates | PD use continued to decline for 2 years, and then began to increase. |
Hornberger (2012) [48] | USA | the 2011 PPS | modality choice | It caused increased use of PD but continued to discourage use of home HD. |
Pisoni (2014) [49] | USA | the 2011 PPS | vascular access use | AVF use increased, while catheter use declined (from 2010 to 2013) |
Tentori (2014) [50] | USA | the 2011 PPS and recent guidelines | 1-serum PTH, total calcium, and phosphorus levels; 2-mineral and bone disorder (MBD) related treatments, including IV and oral vitamin D analogues, cinacalcet, and phosphate binders | Upper limits of targets for PTH and calcium levels increased, while phosphorus targets remained unchanged. No changes were in IV vitamin D or cinacalcet prescription. Many facilities switched IV vitamin D preparation from paricalcitol to Doxercalciferol during this period. Phosphate binder use increased. |
Park (2015) [51] | USA | integration of Part D renal medications into the bundle | Oral phosphate binder medication budget impact | The phosphate binder costs increased. |
Pisoni (2012) [52] | USA | from August 2010 to August 2011 | EPO use, Hgb levels, IV iron use, serum ferritin and PTH levels | epoetin dose and Hgb levels declined. IV iron use, serum ferritin levels, and PTH levels increased. |
Vanholder (2012) [53] | Seven countriesp | dialysis reimbursement in 7 countries | NA | Bundle of services and incentive programs in dialysis payment system of each country were explained. |
Ponce (2012) [54] | Portugal | Portuguese dialysis reimbursement | NA | transitioning from a FFS reimbursement to a capitation system with quality indicators (P4P) |
Maddux (2012) [55] | USA | the 2011 PPS (first year) | patient care | The impact on clinical care and patients is substantial. |
Robinson (2013) [56] | USA | the 2011 PPS, the DOPPS practice monitor | NA | the DOPPS practice monitor provides timely representative data to monitor effects of the expanded PPS on dialysis practice. |
Golper (2011) [57] | USA | the 2011 PPS | Home dialysis | It may encourage home dialysis. |
Wish (2009) [58] | USA | the 2011 PPS | EPO use, IV iron use, Hgb level | The reform’s relevance to anemia management is indisputable. |
Naito (2006) [59] | Japan | Japanese dialysis reimbursement | Modality selection | HD replaced by more efficient treatment options. |
Swaminathan (2012) [60] | USA | The U.S. dialysis reimbursement changes until 2011 | Cost | It is uncertain whether bundled payments can stem the increase in the total cost of dialysis. |
Rivara (2015) [61] | USA | The U.S. recent dialysis payment reforms | Home dialysis use (PD and HHD) | The utilization of PD increased. Utilization of HHD has also grown, but the contribution of the expanded PPS to this growth is less certain. |
Fuller (2013) [62] | USA | the 2011 PPS | Anemia Management | Overall, changes in anemia management were substantial in 2011 but relatively stable by mid to late 2012. |
Piccoli (2019) [63] | NA | Dialysis Reimbursement models | Clinical choices | Each reimbursement model leads to especial outcomes. |
Dor (2007) [15] | 12 DOPPS countries | dialysis reimbursement systems | NA | comparative review of 12 countries shows alternative models of incentives and benefits. |
Durand-Zaleski (2007) [64] | France | Dialysis Reimbursement | NA | pay for medical center: global in public hospital, FFS in private hospital (it is moving toward activity-based reimbursement) /pay for nephrologist: Salary (in public hospitals), FFS (in private clinics) |
Pontoriero (2007) [65] | Italy | Dialysis Reimbursement | NA | pay for medical center: FFS (bundled fee), pay for nephrologist: salary |
Nicholson (2007) [66] | England and Wales | Dialysis Reimbursement | NA | pay for medical center: global budget through prospective payments (service level agreements) or fee for service (per outpatient HD treatment), pay for nephrologist: FFS, salary |
Luño (2007) [67] | Spain | Dialysis Reimbursement | NA | pay for medical center: FFS (bundled fee), pay for nephrologist: salary |
Fukuhara (2007) [68] | Japan | Dialysis Reimbursement | NA | pay for medical center: FFS (bundled fee), pay for nephrologist: salary |
Kleophas (2007) [69] | Germany | Dialysis Reimbursement | NA | pay for medical center: capitation, FFS (for individual providers), pay for nephrologist: FFS |
Wikström (2007) [70] | Sweden | Dialysis Reimbursement | NA | pay for medical center: global budget, pay for nephrologist: salary |
Ashton (2007) [71] | New Zealand | Dialysis Reimbursement | NA | pay for medical center: global budget, pay for nephrologist: salary |
Manns (2007) [72] | Canada | Dialysis Reimbursement | NA | pay for medical center: global budget, pay for nephrologist: FFS |
Hirth (2007) [73] | United States of America | Dialysis Reimbursement | NA | pay for medical center: capitation, pay for nephrologist: capitation, FFS (for separately billable services) |
Van-Biesen (2007) [17] | Belgium | Dialysis Reimbursement | NA | pay for medical center: capitation, pay for nephrologist: FFS |
Harris (2007) [74] | Australia | Dialysis Reimbursement | NA | pay for medical center: currently global annual budget (they are going to a move toward capitation payment for fixed costs and a case payment for variable costs (per dialysis episode)), pay for nephrologist: FFS |