Many cases treated at long-term care hospitals (LTCHs) require ongoing dialysis for renal failure. It is widely believed that dialysis significantly impacts hospital costs. Frequently, patients on dialysis are medically complex and often have been hospitalized primarily for treatment of other conditions, aside from renal disease. Because diagnostic related group assignment is primarily driven by principal diagnosis, many of these patients are grouped with patients that do not require dialysis and may have lower costs. In recognition of the high cost associated with dialysis, the Centers for Medicare & Medicaid Services (CMS) provides an additional payment to some short-term acute care hospitals (STCHs) under the inpatient prospective payment system (IPPS) for inpatient services provided to end-stage renal disease (ESRD) beneficiaries who receive dialysis treatment during a hospital stay. However, no similar policy exists for LTCHs. In this study, we tested whether LTCH cases receiving renal dialysis have higher standardized costs, relative to other cases. We also determine the number of additional hospitals that would qualify for supplemental dialysis payments if a variation on the IPPS supplemental dialysis policy were also applied to LTCHs.
Services : Payment Policy & Delivery System Innovation Expertise: Healthcare Cost and Utilization, Medicare
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