Kidney Failure and the Federal Government (1991) / Chapter Skim
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Introduction
Introduction
Pages 23-36
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The Medicare ESRD program introduced hope where there was none, saving several hundred thousand Americans from premature death by making life-saving treatment financially possible. It has been remarkably successful in fulfilling its intended objectives.
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The committee recognizes, however, that Congress must weigh these recommendations against competing uses of resources and make the appropriate allocation decisions. The IOM committee, therefore, endorses the following objectives for the Medicare ESRD program: to guarantee access to treatment for all for whom it is medically appropriate; to provide care of high quality that achieves desirable health outcomes consistent with patient health status and current professional knowledge; to develop policies that steadily improve patient wellbeing and patient outcomes; and to manage the program prudently at the lowest cost compatible with adequate care.
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Congress addressed kidney transplantation as well during the study. The National Organ Transplant Act of 1984, which amended the Public Health Service Act and expanded the federal government's interest in whole-organ transplantation beyond kidneys, authorized the creation of the Organ Procurement and Transplantation Network.8 That law was amended in 1986
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Louis; a survey of the state certificate-of-need (CON) programs that affect the ESRD program; a survey of state expenditures for ESRD purposes by state Medicaid programs, state medical assistance programs, and state kidney disease programs; and three analyses of the effects of the 1983 composite rate on mortality, hospitalization, and dialysis unit staffing.
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The Bureau of Policy Development supplied audited and unaudited cost data for 1985 and unaudited cost data for 1987 and responded to a number of queries from project staff. In June 1990, the Health Standards and Quality Bureau staff briefed the IOM staff on their quality assurance initiative.
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aNew ESRD patients during the reference year. bFigures are for patients currently enrolled in the Medicare ESRD program as of July 1 for 1974-77 and as of December 31 for 1978-89.
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has estimated that the total direct medical payment from all sources for Medicare and non-Medicare ESRD patients in 1988 was $5.4 billion. Based on 1987 cost data provided by HCFA, the annualized Medicare expenditure for a dialysis patient (for renal and nonrenal care)
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Eggers, Health Care Financing Administration, unpublished data, 1990. TABLE 1-4 Cumulative Percentage Change in Medicare End-Stage Renal Disease (ESRD)
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Program: Patient Growth Versus Real-Dollar Benefit Payment Growth Year ESRD Annual Patient Growth (%) ESRD Annual Real-Dollar Expenditure Growth (%)
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Medicare 1974 229 12,881 1.8 1975 361 15,742 2.3 1976 512 18,621 2.7 1977 641 22,175 2.9 1978 800 25,756 3.1 1979 1,011 30,221 3.3 1980 1,253 36,484 3.4 1981 1,477 43,541 3.4 1982 1,662 51,301 3.2 1983 1,898 58,579 3.2 1984 2,003 64,329 3.1 1985 2,128 69,924 3.0 1986a 2,423 75,389 3.2 1987a 2,702 81,511 3.3 1988a 3,011 89,300 3.4 NOTE: Data may underestimate actual ESRD benefit payments. See note 10.
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Chapter 5 discusses special ESRD patient groups: pediatric, elderly, diabetic, hypertensive, and black and nonwhite renal failure patients. Chapter 6 describes the nature and structure of dialysis and transplantation providers (facilities and centers)
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10. The ESRD Quarterly Statistical Summary, prepared by the Bureau of Data Management and Strategy, HCFA, publishes the only historical ESRD expenditure data series.
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This new method of matching ESRD PMMIS enrollment records with MADRS identifies some ESRD patients who were previously not captured by the PMMIS data base and thus results in higher expenditures than previously attributed to the ESRD program.
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1987. Effects of the 1983 "Composite Rate" changes on ESRD patients, providers, and spending.
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