The 21st Century Cures Act of 2016 lifted regulations in 2021 that prohibited Medicare Advantage enrollment after patients began dialysis treatment, prompting increased MA enrollment among dialysis patients, the Health Affairs study said.
Medicare Advantage plans are already popular with Medicare-eligible patients and now cover 45% of all Medicare members.
Dialysis is the primary treatment for end stage renal disease patients, who are typically eligible for Medicare regardless of age. In 2020, more than 80% of the 525,000 patients receiving dialysis treatment were enrolled in Medicare, the report said, citing federal data.
A large shift of dialysis patients into Medicare Advantage could disrupt the market, the study said, because the consolidated dialysis industry would be able to negotiate payment from MA plans higher than for fee-for-service Medicare. In the dialysis market, large suppliers provide more than three-quarters of all dialysis treatment, the report said.
The study found that MA plans at three large insurers representing nearly half of the Medicare Advantage market in 2016 to 2017 paid 27% more for the median outpatient dialysis treatment than fee-for-service Medicare, with larger dialysis center chains commanding higher markups. Nearly all facilities of the two largest chains were in network, suggesting that larger dialysis chains leverage their market power into all-or-nothing negotiations with plans, the report said.
The findings contrast with those from non-dialysis settings, where MA provider payments are similar to or lower than those for fee-for-service Medicare, the researchers said.
Increasing MA plans’ risk-adjusted payments for patients with end stage renal disease could temporarily alleviate the financial pressure on some plans but inflate the overall cost of care to Medicare, the study said.
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Topics covered: M&A, health IT, care delivery, healthcare policy & regulation, health insurance, operations and more.
Physicians warn that the Supreme Court ruling will have a dire impact on training, ultimately affecting patient care.
Sweeping rules prohibiting information blocking and standardizing EHR and software data exchange came at a pivotal time, as the COVID-19 public health crisis quickly highlighted the stark need for smoother data sharing systemwide.
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