FlashMed

Despite the landmark reform to US dialysis payment with PPS implementation in January 2011, many practices have changed little during this early transition period, and we have seen no early trends in clinical event rates. The most notable findings early in the expanded bundle era include a decrease in average hemoglobin levels and a substantial increase in PTH levels. There has been a notable decrease in erythropoietin doses at the higher end of the dose range, as well as an overall increase in intravenous iron use. Large changes in the use of intravenous vitamin D or oral mineral and bone disorder medications are not yet apparent. In response to the 2010 Government Accountability Office report suggesting a focus on higher cost populations, the most notable difference to date is a larger decrease in average hemoglobin levels in African American versus other patients. Reasons for the observed differences by race, such as the role of facility characteristics (eg, racial mix, payer mix, facility size and location), require investigation. Future monitoring of these trends, confirmation with national data when eventually available, and understanding their effect on clinical outcomes, if any, are warranted.

Additional DPM graphics, underlying data tables, and trends by facility characteristics, such as dialysis organization size, are provided at the DPM website, which is updated on a bimonthly basis.