| Cost-quality trade-offs in dialysis care: a national survey of dialysis facility administrators. | |
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MedLine Citation:
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PMID: 11774110 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Dialysis facilities face important trade-offs between cost and quality under constrained capitated reimbursement. How management at dialysis facilities makes decisions affecting cost and quality of care and views opportunities and threats is unknown. We conducted a national survey of dialysis facility administrators. We asked administrators what changes they would make in response to increases or decreases in reimbursement, their views on linking dialysis care payment to quality-of-care measures, and their views on providing patients with treatment options and outcomes information. One hundred fifty-seven of 280 dialysis facility administrators (56%) responded. If dialysis reimbursement were to increase by 20%, the five most common responses were to: improve patient education programs (62% of respondents), improve facility amenities (42%), purchase new equipment (30%), provide more money for staff salaries (28%), and increase number of nursing staff (21%). Conversely, if dialysis reimbursement were to decrease by 20%, the most common responses were to: limit staff salary (45% of respondents), decrease nursing staff (41%), not replace dialysis equipment (43%), increase dialyzer reuse (37%), and return less to investors (36%). Differences in rank order of responses were observed according to professional training of the administrator and profit status of the facility. Administrators uniformly believe that it is very acceptable to provide facility-specific outcomes data to the public, as well as information on modalities of treatment provided by facilities. However, administrators varied in their views regarding whether reimbursement should be based on quality by using a process-of-care measure, such as the average dose of dialysis, or an outcome-of-care measure, such as case-mix-adjusted mortality rates. We conclude that increases in facility reimbursement generally would be used by dialysis facility administrators for the benefit of patients, whereas decreases (or inflation erosion) in payment rates might compromise staffing. US dialysis administrators support sharing treatment options and outcomes information with patients, but appear to be ambivalent with regard to linking reimbursement to adequacy of dialysis or patient outcomes. These results have important implications regarding proposed changes in the US capitated dialysis payment rate and current efforts to empower consumers of dialysis care. |
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Authors:
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Neil R Powe; Mae Thamer; Wenke Hwang; Nancy E Fink; Eric B Bass; John H Sadler; Nathan W Levin |
Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: American journal of kidney diseases : the official journal of the National Kidney Foundation Volume: 39 ISSN: 1523-6838 ISO Abbreviation: Am. J. Kidney Dis. Publication Date: 2002 Jan |
Date Detail:
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Created Date: 2002-01-04 Completed Date: 2002-04-03 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8110075 Medline TA: Am J Kidney Dis Country: United States |
Other Details:
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Languages: eng Pagination: 116-26 Citation Subset: IM |
Copyright Information:
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Copyright 2002 by the National Kidney Foundation, Inc. |
Affiliation:
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Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA. npowe@jhmi.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cross-Sectional Studies Decision Making Educational Status Humans Kidney Failure, Chronic / therapy* Middle Aged Physicians* Questionnaires Reimbursement Mechanisms / economics Renal Dialysis* / economics, standards United States |
| Grant Support | |
ID/Acronym/Agency:
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HS08365/HS/AHRQ HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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