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APHA Scientific Session and Event Listing

Recorded presentation

John D. Sullivan, PhD, Administrative Sciences, Boston University, 808 Commonwealth Ave, Boston, MA 02215, 617 353 3016, jsulliva@bu.edu

The Medicare Modernization Act of 2003 and its potential economic impact on the delivery of care to end stage renal disease patients.

This paper explores the financial and economic evolution of the Medicare end stage renal disease program and the continued practice of cost shifting by the federal government. The program, as it exists today, is one of the few forms of universal health care in the United States. Under a policy enacted in 1973, each qualified American, regardless of age, is covered for dialysis treatment under Medicare Part B. Dialysis providers have operated under such stringent cost caps, profitable operations have had an emphasis on improving productivity. Presently, ESRD patients make up less than 1% of the Medicare population and expend more than 6% of the Medicare budget. While the cost, on a per treatment basis, has remained relatively flat, Medicare has continually shifted the financial burden to the private sector through an erosion of the reimbursement rate through inflation, extending the Medicare Secondary Payer period, and the possible impact of the Medicare Modernization Act of 2003 on reimbursement for drugs such as EPO. Administrators of dialysis clinics will find it increasingly difficult to provide care to these patients and maintain financial stability. This presentation will examine the potential economic impact for providers of care to these patients.

Learning Objectives:

• Evaluate the potential changes in reimbursement for ESRD patients and its economic impact on an orgainzation.
• Analyze the potential risk to a dialysis provider based on the payer mix
• Develop a strategy to ensure future profitability

Keywords: Economic Analysis, Management and Sustainability

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation