According to the United States Renal Data System, use of home dialysis has increased since 2017. Across all payer types, the greatest growth has been seen in home hemodialysis. The Advancing American Kidney Health (AAKH) executive order set a goal of initiating home dialysis or preemptive kidney transplant for 80% of patients with incident end-stage renal disease (ESRD).
While new payment models from the Centers for Medicare & Medicaid Services (CMS) reward payers for achievement of higher rates of home dialysis, use of home hemodialysis is lowest among patients with Medicare Advantage health insurance coverage: 1.3% versus 3.0% among patients with original Medicare fee-for-service (FFS) coverage without Medicaid.
During a poster session at the National Kidney Foundation Spring Clinical Meetings 2023, Stephan Dunning, MBA, and colleagues at Outset Medical, Inc., San Jose, California, reported estimates of the per-member per-month (PMPM) costs for a Medicare Advantage health plan and 5-year savings generated by incentivizing home dialysis aligned with the AAKH goal. The poster was titled Home Hemodialysis Can Help Reduce Total Cost of Care Among Medicare Advantage Members With ESRD.
The researchers modeled a Medicare Advantage health plan with 500 members on dialysis. They included inputs from the CMS 2023 dialysis-only per capita cost of $9332.69 and dialysis member cost components (inpatient, outpatient, dialysis, physician, and so on) using the CMS bid pricing tool. To reflect the respective negotiating power for larger versus smaller dialysis programs with private payers, dialysis reimbursement was estimated at $337.27 per treatment (27% above the 2023 FFS base rate) for in-center hemodialysis and $302.75 (14% above the base rate) for regional home dialysis providers.
Inflationary factors were used for capitation and costs. Literature and the Tablo® Home Hemodialysis System investigational device exemption trials were used to draw other model assumptions for new dialysis starts, mortality, transplant, modality choice, retention, and relative event rates.
At the end of the 5 modeled years, an estimated 172 members would be on Tablo home hemodialysis (30%). The 5-year average PMPM for members on home hemodialysis ($9277) was roughly equal to that of patients on peritoneal dialysis ($9319). PMPM costs for in-center hemodialysis would be $9963, resulting in $686 PMPM savings with home hemodialysis versus in-center hemodialysis. Over the 5 modeled years, the total savings would be $4.2 million.
“Medicare Advantage plans have been slow to join CMS in incentivizing home dialysis for either providers or members,” the researchers said. “This modeled analysis demonstrates substantial cost savings by Medicare Advantage health plans through home hemodialysis expansion with innovative home dialysis technologies like the Tablo Hemodialysis System.”
Source: Dunning S, Aragon MD, Alessandri-Silva A. Home hemodialysis can help reduce total cost of care among Medicare Advantage members with ESRD. Poster #358. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas.