The relatively new End-Stage Renal Disease (ESRD) payment system for Chronic Kidney Disease (CKD) patients, also known as the bundle, is the biggest change in decades on how dialysis is reimbursed and "will change the business and practice management strategies of dialysis clinics," suggests Renal Business Today. Under this bundling system, which took effect in January 2011, dialysis centers are reimbursed a flat fee to cover dialysis and previously separately billable medications and services.
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BioTrends Research Group, one of the world's leading research and advisory firms for specialized biopharmaceutical issues, reports that nearly three times as many surveyed Nephrologists who actively treat CKD patients thought positively about bundling versus when the dialysis bundle was first introduced. However, they note that more than 40 percent of the surveyed Nephrologists are under high pressure from their dialysis unit to restrict measurement of nonessential labs and have more stringent hemoglobin targets resulting in less erythropoietin stimulating agent (ESA) use.
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This may directly result in negative health outcomes for CKD patients, specifically those on dialysis. For instance, a
study by Truven Health Analytics showed that since the introduction of bundling and changes to ESA labeling (approved by Food and Drug Administration in 2011), epoetin alfa (EPO) use and mean hemoglobin (Hb) levels have decreased and the proportion of patients with Hb levels below 10 g/dL have increased (Hb range for CKD: 11-13).
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The authors of the study which was presented at the National Kidney Foundation's Spring Clinical Meeting, noted that decreases in ESA use and Hb levels may increase the potential need for Red Blood Cell transfusions in ESRD patients. Also, since transfusions are excluded from bundling, there is a potential for clinics to increase the use of transfusions to supplement ESA treatment. While blood transfusions may be an effective treatment for CKD patients, there are increased risks when compared to ESAs. Though rare due to strict regulations, blood transfusions may cause allergic reactions, fever, blood infections, iron overload and other serious side effects that can be harmful to CKD patients and make them less eligible for a Kidney Transplant.
Previous research also highlighted the fact that the proportion of dialysis patients who received a transfusion increased by 24% from September 2010 to September 2011 based on data from the U.S. Renal Data System. While those on dialysis should not despair, they should remain very vigilant about their care. KidneyBuzz.com finds this to be a very important issue to continually monitor and discuss with your Healthcare Teams because it can affect your ability to lead an extended and quality life as well as receive a Kidney Transplant.
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Staff, Mayo Clinic. "Blood Transfusion." Http://www.mayoclinic.com/. Mayo Foundation for Medical Education and Research.
"Bundle Payment." Renal Business Today. Virgo Publishing, LLC.
Charnow, Jody A. "Transfusions On the Rise in Dialysis Patients. "Www.renalandurologynews.com. Renal & Urology News.
BioTrends Research Group. "Although Physicians' Overall Impressions on the Dialysis Bundle Are More Positive, Cost Concerns Remain High, Especially as Dialysis Units Prepare for Continued Changes." Http://www.sacbee.com/. The Sacramento Bee.