End stage renal disease, 1993-95

108 Pages·1997·4.5 MB·English

by  United States. Health Care Financing Administration. Bureau of Data Management and Strategy

P-
Health Care
Financing
Research
Report
End Stage Renal Disase, 1993-95
^^ DepartmentofHealthandHumanServices
ft? HealthCareFinancingAdministration
\ ^^ BureauofDataManagementandStrategy
to^C>i-f*?
Health Care
Financing
Research
Report
TheHealthCareFinancingAdministration TheOfficeofResearchandDemonstration
(HCFA)wasestablishedtocombinehealthcare (ORD)conductsstudiesandprojectsthatdemonstrate
financingandqualityassurancewithinasingle andevaluateoptionalreimbursement,coverage,
apgreongcrya.m,HFCedFeAralispraerstpiocnispaitbiloenfionrtthheeMMeeddiiccaairde eFleidgeibriallitpy,roagnrdammsa.naIgneamdedinttioanl,teOrnRatDiveexsatmoitnheesptrheesent
program.^andavarietyofotherhealthcarequality impactofHCFAprogramsonhealthcarestatus,
assuranceprograms. utilization,andexpenditures,aswellastheireffecton
ThemissionofHCFAistopromotethetimely beneficiaryaccesstoservices,healthcareproviders,
deliveryofappropriate,qualityhealthcaretothe andthehealthcareindustry.
bTmbeeihnnleeelffiaiiogccnieiaoanrrfciiyteehssmeouaNfrsaetittaisawolpnasr'oroseegnarosgafuemtdrsh,e-eadtsphiepasrtarvbopilxrceieodms,garftaoaenrmldwypho7io6crh. tHshiCgenFriHefAseiucaplaltrntstohogfCfrianamrdmaiejnsoFgtrsiafntsfahtnaucTtdihianeefgssfeeaRcnetrdseHeppoaCrrroFtcjsAheccRtpoesnrptocoagorirntnadsmupscrtaeesndednbty
theyareeligible,thatthoseservicesareaccessible areusedasthebasisformakingprogramchanges.
andofhighquality,andthatagencypoliciesand TheEndStageRenalDiseaseResearchReport,
actionspromoteeffiencyandqualitywithinthe 1993-1995reflectsawiderangeofdataandanalyses
-totalhealthcaredeliverysystem. regardingtheMedicareendstagerenaldisease
% TheBureauofDataManagementandStrategy program.Thisreportemphasizestrendsand
"(BDMS)operatesHCFA'sstatisticaldatasystems comparisonsovertime,makingitastandard
andmaintainsthenationalMedicarestatisticalfiles. referencesourceofillustratingchangesinthenature
BDMSalsoservesasthefocalpointwithinthe oftheMedicareendstagerenaldiseasepopulation
agencyforinformationsystempolicyplanning,and andforexaminingthepatternoftreatmentforthese
datastandardsdevelopment. patients.
Health Care
Financing
Research
Report
EndstageRenalDisease, 1993-95
Departmentof HealthandHumanServices
HealthCareFinancingAdministration
RoomN2-14-17
7500SecurityBoulevard
Baltimore,Maryland 21244
October1997
HCFAPub.No. 03393
Acknowlegements
WewishtothankArtie.Shelton,M.D.,
DepartmentofVeteransAffairs;JeromeI.Tokars,M.D.
CentersforDiseaseControl;andtheEndStageRenal
DiseaseNetworkOrganizations,fortheircontributions
tothisreport.
1
Contents
Introducdon 1
Incidenceandenrollment 3
Programincidence 3
Programenrollment 13
Patienttreatmenttrends 19
Treatmenttrends 19
Dialysispatients 19
Transplantpatients 20
Accesstotransplantation 2
Endstagerenaldiseasefacilitydataandpatientcounts 30
DepartmentofVeteransAffairsdialysisstatistics 46
Survivalanalyses 47
Data 47
Results 47
Hospitalinpatientutilization 55
Data 55
Results 55
Programexpenditures 67
Data 67
Results 68
Providersofrenalcare 81
Growthinnumbersandtypesofrenalproviders 81
Typeofrenalcareprovided 81
Endstagerenaldiseasestudies 85
CentersforDiseaseControlsurvey 85
HealthCareFinancingAdministrationgrantactivitysummaries 86
Appendixes
A.Glossaryofterms 91
B.Entitlementprovisions 95
C.Endstagerenaldiseasedatasources 97
111
.
Listoftables
2,.. MMeeddiiccaarreeeennddssttaaggeerreennaallddiisseeaasseepprrooggrraammiinncciiddeennccee,rbaytesagpee.rsmeixllriaocne,po^p'u^l'atPi'o^n^,Zb^y'^a^g^e,l^s^e'x.-^ra^c^e^,^a^n^dprimary '^
43567.... dNMAdMMiive^eeaaeddigwgriincnacocoaesagasnriirerdsrsee:,MseeeepU1nndnag9idddt8ceisaes9stnrtrt-tae'aa9sgngeg4'aeeelesrrrntdeeedaninntasaausllelstaadddasgitiieesss3eeepr0aaaaestssndeieeaaelypnppstrdrrs:iooosgggperer1rara9aas9mmmem0ipi-iilnr9nnlccco4iiiiogdddnreeeapnnnmocccepeeiurnmmlacooatiddtedaaiselloniipnctteeyyrf,,ormraibbtlyyselesiaaloggepneece,,trPess-«deePxx',,.^f'°rr"aa"^cc"°ee;"P,,'-""aaK^n„n^v^hdd,«^p„p';r^rrt^^ia'iitm^«mm^^=^-aa^.^rrr^^yyv^1'9'^8'9^'-'9^'4,990.94 ,^^890^^
Z
I: M^Z7.6 -a.disease'pro^enrollmentfordialysispatientsbyage,sex,race,andpnman.
10. MS^elid's'tagtrenaldiseaseprogramdialysisenrollmentpermillionpopulation,byage. 16
1121.. sMsMfeeueexxnddciitrrcciaaaaoccrre£nee,.inaeaegnnnndgdddrapspsftrtrtaaiisgg,mmeeaabrrrryyyeennaddaagiilleaa.ddggiinnssosoeesexsaia.isss:ereapcp1e1rr9,9oo88gga99rnr--ad9a9m4m4preeinnmrraoolrllylmmdeeinnattgnfpooesrripsma:itlil1ei9no8tns9-pw9oi4ptuhlaftuinocntifoonrinpgatgireantt«tss.wiubtyha,g„e-,
11113456.... DEDKiiniaaddllnyysesstiyiassgteppraaarttneiisneepannltltassn,dticsobpemayatpsilMeeeentddtisiia,nclgabyrsytiersMacieponodivpineucgrl,aaargtbeeiy:ocnto,yv1pe9ber8ya3ogt-fey9d:p5iea1lay9ns8id3s-:p1l19a9c9e950o-f,1,d9.i9a5l,ysi.s:.19o9o0n-9o5^ 2^^4^^
1178.. KMieddneiyatreanesnpdlasnttasg,ebreynadlondiosretayspee:pr1o9g8r3a-m95transplants,byage,sex,race,andprima,r„y,^dii,a„g„nno,siics-. 11Q98809-9944 2256
2222101923..... PAATEarccntaccdineesessstnptasslsgattcnaoortwettaarhntiaeaitnloiOsdnnpPiglasaTftentrNtaeaasrntewsOifapoPialnatc,TniitbNnlsgyi:twlaiai1gsie9tets8.bs5lyusi-ers9taxv5g.ebeyyr,eaadcsge,ee,x.b,aysrneadSxct.epa,trre&ia:cmea1.pr9ry&9i5dmiaparrgyinmodasiirasyg:ndoi,1sa„9igs„9n:«0o-s1o9i.9s4:90-199940-94 2^^^7^2^
22222233346758092.1..... DDPPDOPDKiaaiiauiiattatataldiiilpllyeeneyyaysnnnseststittiiyisisssssepsrtrncatptreetotrraacc-ieatndeeenaisiiiinpntpacvvtlimlliinceneyannlttgnsngigicitttgnsoccrigasuaaebtcenrriarattetecltitsaivsimiaetitnenntlmtgynafcysthtt-orthsoddi.faei.umotgca.renouilniusa,yvgdnt.sleipgibsvnbssayuetttydtmnhaiSurmegeStadraetnaicuiarttnarrtneyieelsi:g,n:neengattDngbtlh1deciye9taoncdh9rgupicee,5rslamyesalcbebaceeaayesenlrder:deSouatnpfra31rdati9adt1eyni9ir.:eage5aln1yDrytte9s,hsea9i,erc5bs,e:bcymbya1Slybt9Seeat9nStratd5etaa:e3tr:e1:1y.9e1191a9995r999555bySute:1995 3^^^^^^^^3^^^^^^^^
33333343443456780192........ DKNDDDNCDLiiiiiuiuaissdaaavmdmtlplnlibabryyoeyncivsssesygbriieiti-russosrrnttfeiiopippdplnaofaoaoaatstnntktniitipoieoeoeeilfdndnfnraecttntnnakdsstettdsiorybcruadsnaereyvnnfotvcnseerorieptparyrvrilentiaoDvarsrtcfleinpapri,knptnlaatigasabntdapnsrpyicnltnpateaeasltdamrmnayigeeeptnesnelnetn.,obpisttrnyagsofbptsaiefroytiunxboVrrey.disfvnemploiittereniuvtaedsuratcoruplcyemfara,re,sbvnonf:tiebaadvsavciynrA1tiatddl9lfuyeaoi,9sfrgptpf5.ayseerb:tb,.iiyro>rmab1sfsaane9ySgdsdxr8tep,oiyaS3,lntat-aredaolsan9:tiryect5ea,xess:g1,,,.nb91soary9b9safn5yic9aSdest5cS,:atp.taralet1i:nie9md:t91ai0p9r1e-r9y9s9i59,4dm5biayargtynyopdsieiao„sg:ffnHodi'si,9ialls9yv:0s.-ik19s-9.4911099-889884-9922 ^^^^^4^551^^^^6,02
IV
1
43. Cadaverdonortransplantgraftsurvivalofpatients,byage,sex.race,andprimar>diagnosis:19%-')4
44. Living-relateddonortransplantgraftsurvivalofpat:;nts.byage,sex,race,andprimarydiagnosis,1990-04 54
45. Medicareendstagerenal'diseaseprograminpatienthospitalutilization,bypatienttreatmentgroup; 1989-94 5SI
46. Medicareendstagerenaldiseaseprograminpatienthospitalutilization,bypatienttreatmentgroup,excluding
Medicaresecondarypayerpatients:1989-94 60
47. Medicareendstagerenaldiseaseprograminpatientutilizationfordialysispatients,
byage,sex,race,andprimarydiagnosis,excludingMedicaresecondarypayerpatients: 1994 61
48. Medicareendstagerenaldiseaseprograminpatientutilizationfortransplantpatients,
byage,sex,race,andprimarydiagnosis,excludingMedicaresecondarypayerpatienU: 1994 62
49. Medicar-;endsUgerenaldiseaseprograminpatientutilizationforfunctioninggraftpatients,byage,
sex,race,andprimarydiagnosis,excludingMedicaresecondarypayerpatients: 1994 5j
50. Medicareendstagerenaldiseaseprograminpatientutilizationforgraftfailurepatients,
byage,sex,race,andprimarydiagnosis,excludingMedicaresecondarypayerpatients: 1994 64
51. Medicareendstagerenaldiseaseinpatientutilization,byprincipaldiagnosisofhospitalizationbyage,sex,
race,andprimarydiagnosisfordialysispatients,excludingMedicaresecondarypayerpatients: 1994 65
52. Medicareendstagerenaldiseaseprogramexpendituresbypatienttreatmentgroup:1989-94 7
53. Medicareendstagerenaldiseaseprogramexpendituresperpatient,bypatienttreatmentgroup,
excludingMedicaresecondarypayerpatients: 1989-94 73
54. Medicareenditagerenaldiseseprogramexpendituresfordialysispatients,byage,sex,race,
andprimarydiagnosis,excludingMedicaresecondarypayerpatients:1994 75
55. Medicareendstagerenaldiseaseprogramexpendituresfortransplantpatients,byage,sex,race,
andprimarydiagnosis,excludingMedicaresecondarypayerpatients:1994 6
56. Medicareendstagerenaldiseaseprogramexpendituresforfunctioninggraftpatients,byage,sex,
race,andprimarydiagnosis,excludingMedicaresecondarypayerpatients:1994
57. Medicareendstagerenaldiseaseprogramexpendituresforgraftfailurepatients,byage,sex,race,
andprimarydiagnosis,excludingMedicaresecondarypayerpatients:1994 '°
58. MedicareendstagerenaldiseaseprogramexpendituresbyStatefordialysispatients,excluding
Medicaresecondarypayerpatients: 1994
59. Medicare-approvedendstagerenaldiseaseprovidersofservicebytypeofserviceandnumberofapproved
dialysisstations: 1986-95 ^^
60. NumberandpercentofMedicare-approvedendstagerenaldiseaseproviders,bytypeofownership: 1991-95 82
61. Medicare-approvedendstagerenaldiseaseprovidersofservice,andnumberofapproveddialysis
stations,byState: December1995 83

Endstagerenaldisease, 1993-95
Introduction undercontractwiththeHealthResourcesand
ServicesAdministration.Theprincipalsourcesof
etLSfoeafcpewuecrWrt9iiist2voty-enh6sAJ0ctu3wthli)ey(,teh11fn9,uea7l1nlc29dtM7Am3esem.tdneaitgncTedaoorfmreebesneenacclteotlvsidieoignrtsioabe2lgat9eseh9eef1wo(SaroEosfcSMieeRPadxDultib)elc,inacdreed e(ahSsonuOstdrSpaLviCbeaetlAgnayiiRlsasC)lhnae,amnrnteutdiMniaofetlfnidaocscipafiucatlraasiivtorsnyeneeayditacnioneioffrndnottari1Rhlmf9eeia8psEctae6oiStrooimRtnoraiDngnnaargadnpepiaaSpztttyraihetsoeedinvttoOaetnnlmhrslee.nigointseitcrey.s,
Abibidnenedndseiitufvthriieietddoss,un,paaololtrluhrysebe,eeqpuaaoeitrlpriiehedgsyneitsbpcilemhecnruiodfsaonetnrincmtfSiuordccssihtitaialbllcyedesSriocetsuficrofusryrrueicntathhtyakltayibdetponnhereeerfyfsiuotlnsl.,yor ((MoTCfhiUCicSH)shRe.iaDrgleSTgta)ihhns,et(urNiynCsI,dCHoet)prh.eiesrcaocUTtnunhretieradtecenbUtdtySwlSiyaRttaDtChthoSeetoshrUieRdsneiiNmnnvaaaaetnltriiasoDningatgaeytldCaoeItfnnShstytresiorttuuegtmehs
dtreatnTesrhpmelianMnteeddtioacmmaaoriuenntptarifonogrrlikafeim.dnpaeyystraapnsrpolsapnetcst,ivfeorlycertain" ctthhoeemrcpeooaosrpeeedrtawotofivrmeeapejrfoefrsoerantdtsvaoitfisvoHersCyFfcroAommmainFtdetdNeeeIrsHal.whagFiuecrnhtchiaeerrse,
ddiirmaumlguysntiorsscusaetprmpverinectessss,.i^avFneodrdareucxgoasmmpppolrseeis,tcearsirboaetfdeJfsuoclrhyetdrI,aunl1se9p9lf5ao,nrt aaArndedvitpshreoorfEyexseCscoiumotnmiaivltestCefteo-.mommiAttlhsteoereetnhaaenldDcetophmaemruStcnmiieetnntyti;foif.chHeesaelth
dcewdrMp(opbIfacas(DoifiereoanofarolHnycefafcsetrdmsnsoosdlCeipXcMevTpietbngycptthagelFiehracMsgtiahaerrrdocXxAiiieoeaeeratmautioAwsvntnlggr)dmsvcmteiM)eHeeaaerislesttaeene.ds,niecaJyiorhrsndacdtesaaumwriTteloiitetmrclnlotieinshthvdeciihathentqgboehdmeeaanaegIhhuectfiear.,rrenm1eiinCootodls,aregffeHenraevyprwigafofSeeeddsre1ueEigaEteeierddaiilg9rrechntlstSmlscS,8aetbesfdwofea,taF9tRidoiR-iaydtehlt.ihEivraaptDdrioDbeonltdooPahSydotanyayomlueEtnmmhnenpsRpniltibfhedosiradedonMcihclfrDSseofpgnieiesyeioyrHtdugidsecnacdppaovsbePliredtultaogiglefaatarrcmefLitiMmcelfetame-iAvoovoeteayeaiatme-aedpmtgemhgscdrowindrenmieeilprtrinJetomen(isrinoraa.sncai9nlnvsrSptemfppn(na5eaeioreomMohaihuEr-TtesenrorftesMaMeaiPeh2edgtsvfitdnanIr3cdOi9aErsiermtcsywtnrs2)SacnaiP,ydohioidi,tt,eat)naedevlnOt1fsviisig.ta,aaefeshoueosaEtenrotseorniwns,t1hnsSasdcnrEmdaTear9eltoRmagieShda9absysoisfatJeitfa4nR.ufotatt3iss,pEntDioeeoprP.o,nonOrt• atcppEHHcUdsiapvtooitocrantioCSnSnurloshluuoodswtfledseirFldsRTvRmshHeeocuaipeuiAHehpetcDierDvaetsoCmdmaate,eussmmne,sSeSeiibsr.FaeDmyreesolni,EictpnacaAn,eanaCorisrttoSt,rsnsvtlnooeohCfteatodelRragsanaienthelseturtnnnSADesacpvfhilcdefdeddrtaositritsoeoEroythvsrPonisgduavaviviviSngciMnetrcsnoaneniegsoestihedRrfcaMldrtronadepziaealohcDeI,iDroueettsnpyepopclrtrySsiiasrHoneaeotny(meEoleo,rdcdnntCeeHsnysDvtoiSehdd,tossdimfHSferrwuodRemiedatrtmenHocfmsrsamneoDirloairitecSpeieuneEnmnokkppuahe)avttpoogsfrdsSitaatdftoatref,dshntnosmRhhprtisieiethrtgfeeuiaseeuntoDeofnolncszineftntsbEtttaecodedhodsotfhdae,ntunSieoireaosstitsaotbsstmrRifto^ehpUlrefasynut.anerdreDd.ceESltrbs.denaooaHmaemlSeRaposd.vniPtniClaosttRsnDitnSidseiraunMFrdDTeaSsohcntadtaaeAvtMehtnt.gin.hcgiaeodeelee,edItanroeedsstsdttTafSmEtehtvhhhlohoeeaeieeSnednnacoRaldteftCttaD,hahrCed
epidemiologicalresearch. referenceontheMedicareESRDpopulationandon
infTorhmeatpiroinncaipraelthseouMrecdeiscoafrbeebnielfliicnigarrye-csopredcsifaincd ESRDDaUtrwehaitcmehnthapvaettberenesn.releasedtoHCFAfrom
rti(EiPernnLrSpacfTooniRoNcrsdrDuOtpemlrnSaoabce)tnneemistn-weoeeshnnitfpsitieoocctcafnihhinaefEtrdoiUhSypce.nTRemirrDcetaaTh,detnahiderseaacspNncalpttedlarhetinrecinwuiancnsotufiatirspoitokeacirnlsomofnasNofoatrofelidutoOeaOrwnarrckotgegfihraadooknnnrffoem(SrysOhaaPtnhrTaiNtn)g oAEARhfteuuafhgsrvaeiteoirsrrptasboerl,eryaige,antanhnaaeDinniizCnddaaecltNtnlyihutseoedienwesrCsdsaaZ(nanfeeaond.argddl.TiDa,riainadtnsdehnenesRatDpeisiDlfnaeeaialpneCylatdosrinFwAtstashrmisaeoleonrluncdr,eiteatTaothRrpifeeapognrVniose,sppttrleteiahrranea)ttnes.