Changes in hemodialysis catheter management after introduction of the end-stage renal disease prospective payment system

Nicholas S Roetker,Yi Peng,James B Wetmore,Marquita R Decker-Palmer,Haifeng Guo

doi:10.1186/s12882-020-02222-9

Abstract

BackgroundWe investigated whether implementation of the end-stage renal disease prospective payment system (ESRD PPS) was associated with changes in thrombolytic therapy use and other aspects of catheter management in hemodialysis (HD) patients.MethodsUsing quarterly, period prevalent cohorts of patients undergoing maintenance HD with a catheter in the US Renal Data System (2008–2015), we studied rates of claims for within- and outside-HD-unit thrombolytic use, and thrombus/fibrin sheath removal, and rates of delayed HD treatment after ESRD PPS implementation, January 1, 2011. Associations between PPS implementation and change in trend of rates of each outcome were assessed using covariate-adjusted Poisson regression, using a piecewise linear function for quarter-time (with breakpoint at PPS implementation).ResultsAmong an average of 69,428 quarterly catheter users, rates of claims for within-HD-unit thrombolytic use declined from 236.6 (Q1–2008) to 81.4 (Q4–2012) per 100 person-years (P < 0.0001, PPS association with change in trend); rates of claims for thrombus/fibrin sheath removal procedures increased from 3.9 (Q1–2008) to 8.8 (Q3–2015) per 100 person-years (P = 0.0001, PPS association with change in trend). Rates of delayed HD treatment increased from 1.6 (Q2–2008) to 2.3 (Q3–2015) per patient-quarter, although PPS implementation was associated with a decrease in this rising trend (1.6% increase per quarter pre-PPS, 1.2% post-PPS; P < 0.0001, change in trend).ConclusionsAfter PPS implementation, thrombolytic use decreased and thrombus/fibrin sheath removal increased. The increasing trend in delayed HD treatment appeared to slow after PPS implementation, but delayed sessions continued to increase year over year for unclear reasons.

Highlights

We investigated whether implementation of the end-stage renal disease prospective payment system (ESRD PPS) was associated with changes in thrombolytic therapy use and other aspects of catheter management in hemodialysis (HD) patients
Little is known about how implementation of the ESRD PPS affected thrombolytic use and other aspects of vascular access management, among patients using central venous catheters for hemodialysis (HD) access
Since the ESRD PPS changed the policy for reimbursement of injectable medications for outpatient dialysis facilities only, we identified thrombolytic use separately for claims within vs. outside the dialysis unit

Summary

Introduction

We investigated whether implementation of the end-stage renal disease prospective payment system (ESRD PPS) was associated with changes in thrombolytic therapy use and other aspects of catheter management in hemodialysis (HD) patients. Alteplase and other thrombolytic agents are among the injectable medications that were reimbursed separately from composite rate dialysis services in the pre-PPS period. Including these drugs in the PPS would, in theory, result in a reduction of their use in the outpatient dialysis unit. Little is known about how implementation of the ESRD PPS affected thrombolytic use and other aspects of vascular access management, among patients using central venous catheters for hemodialysis (HD) access. Using the United States Renal Data System (USRDS) database, we sought to investigate whether rates of these downstream consequences increased after implementation of the ESRD PPS, for HD patients using a catheter

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Results

Discussion

Conclusion