High Costs of Dialysis Transportation in the United States: Exploring Approaches to a More Cost-effective Delivery System.

J Mark Stephens,Larry C Emerson,David T Gilbertson,William M Mcclellan,Matthew Gitlin,Samuel Brotherton,Stephan C Dunning,Ann C Mcclellan,Sanatan Shreay

doi:10.36469/9861

Abstract

Background: The costs of transporting end-stage renal disease (ESRD) patients to dialysis centers are high and growing rapidly. Research has suggested that substantial cost savings could be achieved if medically appropriate transport was made available and covered by Medicare. Objectives: To estimate US dialysis transportation costs from a purchaser's perspective, and to estimate cost savings that could be achieved if less expensive means of transport were utilized. Methods: Costs were estimated using an actuarial model. Travel distance estimates were calculated using GIS software from patient ZIP codes and dialysis facility addresses. Cost and utilization estimates were derived from fee schedules, government reports, transportation websites and peer-reviewed literature. Results: The estimated annual cost of dialysis transportation in the United States is $3.0 billion, half of which is for ambulances. Most other costs are due to transport via ambulettes, wheelchair vans and taxis. Approximately 5% of costs incurred are for private vehicle or public transportation use. If ambulance use dropped to 1% of trips from the current 5%, costs could be reduced by one-third. Conclusions: Decision-makers should consider policies to reduce ambulance use, while providing appropriate levels of care.

Highlights

The costs of transporting end-stage renal disease (ESRD) patients to dialysis centers are high and growing rapidly
Travel costs may be especially high for people with end-stage renal disease (ESRD) who receive hemodialysis, as these patients typically have to travel for outpatient treatment three times per week, every week of the year, generally for the remainder of their lives
This was either payments made by insurers, patients or other third parties to the transport provider for the actual services used, or, where no transport provider was paid for the transportation service, a direct cost was calculated based on standard mileage rates

Summary

Introduction

The costs of transporting end-stage renal disease (ESRD) patients to dialysis centers are high and growing rapidly. Travel for medical care can be burdensome from both a time and cost perspective, and may be an important factor in treatment decisions and patient outcomes.[1,2,3] Travel costs may be especially high for people with end-stage renal disease (ESRD) who receive hemodialysis, as these patients typically have to travel for outpatient treatment three times per week, every week of the year, generally for the remainder of their lives. The high cost of transport for hemodialysis patients is due to the frequency of travel, and driven by the physical assistance needs of this population. At least half are transportation dependent, meaning they cannot drive themselves and are unable to take public transit.[6]

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Conclusion