End-stage renal disease

92 Pages·1991·4.6 MB·English

by  United States. Health Care Financing Administration. Office of Research and Demonstrations

Care
Health
Financing
Research
Report
End Stage Renal Disease, 1991
4
PUBS
RA Department of Health and Human Services
645 Health Care Financing Administration
K5 Bureau of Data Management and Strategy
E62
1991
Health Care
Financing
Research
Report
The Health Care Financing Administration (HCFA) was The OfficeofResearch and Demonstrations (ORD)
established tocombine health care financingand quality conducts studies andprojects thatdemonstrate and
assurance within a single agency. HCFA isresponsible for evaluate optional reimbursement, coverage, eligibility,and
the Medicareprogram, Federal participation in the managementalternatives to thepresentFederal programs.
Medicaid program, anda variety ofother health care In addition, ORD examines the impactofHCFA programs
quality assurance programs. on health care status, utilization, andexpenditures, as well
The mission ofHCFA is topromote the timely delivery as theireffecton beneficiary access to services, health care
ofappropr—iate, quality health care to thebeneficiariesofits providers, and the health care industry.
programs approximately 59 million oftheNation'saged, Health Care Financing Research Reports presentthe
disabled, andpoor. Theagency mustalso ensure that results ofmajor studies and projects conductedby HCFA
program beneficiaries are awareofthe services forwhich program staff. These reports contain significant findings
they areeligible, thatthose servicesareaccessibleandof thataffectHCFA programs andare usedas thebasis for
high quality, and thatagency policies and actionspromote makingprogram changes.
efficiency and quality within the total health caredelivery TheEndStageRenalDiseaseResearchReport, 1991
system. reflects a wide rangeofdataand analysesregarding the
TheBureau ofData Managementand Strategy (BDMS) Medicareend stagerenal disease program. This report
operates HCFA's statistical data systems and maintains the emphasizes trends andcomparisonsovertime, making ita
national Medicarestatistical files. BDMS also serves as standard reference source for illustrating changes in the
the focal pointwithin theagency for information systems nature ofthe Medicare end stage renal diseasepopulation
policy, planning, and data standards development. and forexamining the pattern oftreatmentforthese
patients.
Health Care
Financing
Research
Report
End Stage Renal Disease, 1991
Department ofHealth and Human Services
HealthCareFinancing Administration
Bureau ofData Managementand Strategy
OfficeofResearch and Demonstrations
Baltimore, Maryland
May 1993
HCFAPub. No. 03338
Acknowledgments
We wish to thankNeil S. Otchin, M.D.,
DepartmentofVeterans Affairs; Miriam J. Alter,Ph.D.,
andJeromeI. Tokars, M.D., Centers forDiseaseControl;
and theEnd StageRenal DiseaseNetworkOrganizations,
fortheircontributions to this report.
Contents
Introduction 1
Incidence and enrollment 3
Program incidence 3
Program enrollment 12
Patient treatment trends 17
Treatmenttrends 17
Dialysispatients 17
Transplantpatients 17
End stagerenal disease facility dataandpatientcounts 22
DepartmentofVeterans Affairsdialysis statistics 38
Survival analyses 39
Data 39
Results 39
Hospital inpatient utilization 47
Data 47
Results 47
Program expenditures 55
Data 55
Results 55
Providers ofrenal care 65
Growth in numbersand typesofrenal providers 65
Typeofrenal careprovided 65
End stage renal disease studies 69
Centers forDiseaseControl survey 69
Health CareFinancing Administration grantactivity summaries 69
Appendixes
A. Glossary ofterms 73
B. Entitlementprovisions 77
C. Endstagerenaldiseasedatasources 79
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List oftables
1. Medicareend stagerenal diseaseprogram incidence, by age, sex, race, andprimary diagnosis: 1985-90 5
2. Medicareendstagerenal diseaseprogram incidencerates permillion population, by age, sex,race,
andprimary diagnosis: 1985-90 6
3. Medicareendstagerenal diseaseprogram incidenceratespermillion population, by State: 1985-90 7
4. Average Medicare end stagerenal diseaseprogram incidence ratespermillion population, by State: 1985-90 8
5. New end stage renal diseasepatientspermillion population, for selectedcountries: 1985-90 9
6. Medicare endstagerenal diseaseprogram incidencemodality,by age, sex, race, andprimary
diagnosis, patients' statusat30 days: 1986-90 10
7. Medicareendstagerenal diseaseprogram incidencemodality,by age, sex, race, andprimary
diagnosis,patients' status at 1 year: 1986-90 1
8. Medicareendstagerenal diseaseprogram enrollment,by dialysis and functioninggraft: 1978-90 13
9. Medicare endstagerenal diseaseprogram enrollment fordialysispatientsbyage, sex, race, andprimary
diagnosis: 1985-90 13
10. Medicareend stagerenaldisease program dialysisenrollmentper million population,
by age, sex, race, andprimary diagnosis: 1985-90 14
11. Medicareend stagerenaldiseaseprogramenrollment forpatients with functioninggrafts, by age,
sex,race, andprimary diagnosis: 1985-90 15
12. Medicareend stagerenal diseaseprogram enrollmentpermillion population forpatients with
functioning grafts, by age, sex,race, andprimary diagnosis: 1985-90 16
13. Dialysis patients by Medicarecoverage: 1980-1991 18
14. End stagerenal diseasedialysispopulation, by type and place ofdialysis: 1986-91 18
15. Dialysispatients completing training,by typeofdialysis: 1986-91 19
16. Kidney transplantpatients, by Medicarecoverage: 1980-91 20
17. Kidney transplants,by donortype: 1980-91 20
18. Medicareend stagerenal diseaseprogram transplants, by age, sex,race, and primary diagnosis: 1985-90 21
19. Patientsawaiting transplants: 1983-91 22
20. End stagerenal disease facilities surveyed,by State: 1991 23
21. Dialysis patienteligibility status, by State: 1991 24
22. Dialysis patientcounts national summary,by placeofdialysis: 1991 25
23. Patientsreceiving care in theoutpatientsetting, by State: December31, 1991 25
24. Patientsreceiving careathome, by State: December 31, 1991 27
25 Dialysis treatmentsettingofend stagerenal diseasepatients, by State: 1991 28
26. Patientscompleting a self-dialysis trainingcourse during thecalendaryear, by State: 1991 29
27. Outpatientdialysis treatments given during thecalendaryear, by State: 1991 30
28. Dialysis training treatments given during thecalendaryear,by State: 1991 31
29. Kidney transplantactivityduring the calendaryear: 1991 32
30. Disposition ofcadaveric kidneys, by source: 1991 32
31. Kidney transplantcenterpatienteligibility status,by State: 1991 33
32. Numberofkidney transplants performedand type ofdonor, by State: 1991 34
33. Distribution ofkidney transplants andnumberoftransplants,by State: 1991 35
34. Dialysis patients byprofitand nonprofitproviders, by State: 1991 36
35. Dialysispatients receivingcareby typeoffacility: 1982-91 37
36. Numberofpatients forDepartmentofVeterans Affairsdialysis facilities,by typeofdialysis: 1987-91 38
37. Dialysispatientsurvival, by age, sex,race, andprimarydiagnosis: 1986-90 42
38. Cadaverdonortransplant patientsurvival, byage, sex,race, andprimary diagnosis: 1986-90 43
39. Living-relateddonortransplantpatientsurvival, by age, sex,race,andprimary diagnosis: 1986-90 44
40. Cadaverdonortransplantgraftsurvival ofpatients,byage, sex, race, andprimary diagnosis: 1986-90 45
41. Living-relateddonortransplantgraftsurvival ofpatients, by age, sex,race, andprimary diagnosis: 1986-90 46
42. Medicareend stage renal diseaseprogram inpatienthospital utilization,by patient treatmentgroup: 1985-90 49
43. Medicareendstagerenal diseaseprogram inpatienthospital utilization,bypatient treatment
group, excluding Medicare secondarypayerpatients: 1985-90 49
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44. Medicareend stagerenal diseaseprogram inpatientutilization fordialysispatients,
by age, sex, race, andprimary diagnosis,excluding Medicare secondarypayerpatients: 1990
45. Medicareend stagerenal diseaseprogram inpatientutilization fortransplantpatients,
by age, sex, race,andprimarydiagnosis,excludingMedicare secondarypayerpatients: 1990
46. Medicareend stagerenaldiseaseprogram inpatient utilization forfunctioning graftpatients,
byage, sex, race,andprimary diagnosis,excludingMedicare secondarypayerpatients: 1990
47. Medicareend stagerenal diseaseprogram inpatientutilization forgraftfailurepatients,
byage, sex,race, andprimary diagnosis,excludingMedicare secondarypayerpatients: 1990
48. Medicareendstagerenal diseaseprogram expendituresbypatienttreatmentgroup: 1985-90
49. Medicareend stagerenal diseaseprogram expendituresperpatient,by patient treatmentgroup,
excluding Medicare secondarypayerpatients: 1985-90
50. Medicareend stagerenal diseaseprogram expenditures fordialysispatients,by age, sex, race,
andprimary diagnosis,excluding Medicare secondarypayerpatients: 1990
51. Medicareend stagerenal diseaseprogram expenditures fortransplantpatients, by age, sex, race,
andprimary diagnosis, excluding Medicare secondarypayerpatients: 1990
52. Medicareend stagerenal diseaseprogramexpenditures for functioninggraftpatients, by age, sex,
race, andprimary diagnosis,excluding Medicare secondarypayerpatients: 1990
53. Medicareend stagerenal diseaseprogramexpenditures forgraftfailurepatients,byage, sex,race,
andprimary diagnosis, excluding Medicare secondarypayerpatients: 1990
54. Medicare-approvedendstagerenal diseaseprovidersofservice by typeofserviceandnumberofapproved
dialysis stations: 1982-91
55. Numberand percentofMedicare-approvedendstagerenaldiseaseproviders, by typeofownership: 1987-9
56. Medicare-approved end stagerenal diseaseproviders ofservice, and numberofapproveddialysis
stations, by State: December 1991

End stage renal disease, 1991
Introduction Legislationpassedin 1986mandatedtheestablishment
ofanationalESRD patientregistry. Thisregistry, the
With theenactmentofsection 2991 ofPublicLaw UnitedStates Renal DataSystem (USRDS), is operatedby
92-603 (1972 Amendments to the Social Security Act), aCoordinatingCenter (CC). TheCC is currently the
full Medicarecoverage was extended topersons with end Urban Institute undercontractwith theNational Institutes
stagerenal disease (ESRD), effectiveJuly 1, 1973. To be ofHealth (NIH). TheUSRDS is managed through the
eligible forMedicarebenefits, thepatientmustfirstbe cooperativeefforts ofHCFA andNIH. Further, there are
currentlyorfully insured, orbeeligible forSocial Security twomajoradvisory committees which arecomposedof
benefits, orbe the spouseordependentchildofsuch a representativesfrom Federal agencies andprofessionals
person. Additionally, aphysician mustcertify thatthe from therenal community; theseare theExecutive
individualrequires chronicdialysisorakidney transplant Committeeand the Scientific AdvisoryCommittee. Also,
to maintain life. the DepartmentofHealthandHuman Services (DHHS)
TheMedicareprogram paysaprospectively determined has established theESRD DataAdvisory Committee to
amountforkidney transplants, forcertain drug treatments, provideadvice to the SecretaryofDHHS in the
and a compositerate schedule fordialysis services. For formulationofpolicies andproceduresrelevanttothe
example, immunosuppressivedrugsprescribed for management,collection, andanalyses ofESRDdata.
transplantrecipientsarecovered by Medicare for 1 year TheESRDPMMIS maintainedby HCFA provides the
followingdischarge from the hospitalization forthe foundation data fortheUSRDS. However, theESRD
transplant. The drug, erythropoietin (EPO), used to networks, undercontractto HCFA, collectandprovide
combatanemia, wasaddedto Medicarecoverage effective additional data to theUSRDS CC forthe conductof
June 1, 1989. focusedstudieson thecauses,progression,andtreatment
The Health CareFinancing Administration (HCFA) is ofESRD. The CC disseminatesa varietyofreports based
charged with theeffectiveadministration ofMedicare on these studies.
benefits toeligiblepersonswith ESRD. Integral to the HCFArecognizes theneed todisseminatethe
effective managementoftheESRD program is the information developedfrom theESRD PMMIS dataand
operation ofacomprehensivedatabasecovering medical any resultinganalysesofthese dataaspromptly as
and demographic information forthe MedicareESRD possible. Thepurpose ofthis reportistopresent, ina
population. This database, along with otherESRD single volume, statistics concerningrecenttrends in ESRD
program-relateddata, iscontained within theESRD treatmentand detailed discussions ofselected health issues
Program Managementand Medical Information System involving theESRDpopulation. Several ofthe tables in
(PMMIS). This system,asrequiredby Public Law this reportemphasize trends and comparisons overtime,
95-292, section (c)(1)(A), is designedtoserve theneedsof making this reporta standardreferenceon theMedicare
the DepartmentofHealth and Human Services in support ESRDpopulation andon ESRD treatmentpatterns.
ofprogram analysis, policy development,and Data which havebeen released to HCFA from other
epidemiologicalresearch. TheESRDPMMIS includes organizations (e.g., the DepartmentofVeterans Affairs,
information onboth MedicareESRDbeneficiaries and theCenters forDiseaseControl, theEuropean Dialysis
Medicare-approvedESRD hospitals and dialysisfacilities. and Transplantation Association, the AustraliaandNew
Theprincipal sourcesofbeneficiary-specific Zealand Dialysis andTransplantRegistry, andthe
information arethe Medicarebillingrecords and CanadianRenalFailureRegister) havebeen includedand
incidence-specific medical information forms thatreport identifiedwhereappropriate.
onsetofESRD, characteristics andstatusofakidney
transplant, and cause ofdeath foranESRDbeneficiary.
Theprincipal sources ofhospital andfacility information
are theMedicarecertification approval notices andan
annual survey oftheseorganizations.
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