Comparison of mortality and intermediate outcomes between medicare dialysis patients in HMO and fee for service

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
P W EggersMichael V Rocco

Abstract

End-stage renal disease (ESRD) is the only disease entitlement for Medicare; therefore, most patients with ESRD have Medicare coverage. Patients with ESRD are prohibited by law from enrolling in health maintenance organizations (HMOs), the only group prohibited within Medicare. However, they may remain in an HMO if they enrolled in such a plan before their kidneys failed. Thus, it is possible to compare patients with ESRD in HMOs with those in fee-for-service (FFS) plans. To determine whether mortality, transplantation rates, and intermediate outcomes differed between Medicare ESRD beneficiaries enrolled in HMO versus FFS providers, a retrospective cohort analysis was performed of patients with ESRD from three Health Care Financing Administration data sets containing administrative and outcome information for Medicare ESRD beneficiaries from 1990 to 1998. On December 31, 1998, a total of 278,510 prevalent patients with ESRD were in FFS plans, and 18,332 patients were in HMOs. HMO patients were older and more likely to be white and male and have diabetes mellitus and comorbid cardiovascular conditions than FFS patients. Unadjusted 2-year survival rates were 48.4% and 49.3% for FFS and HMO patients, respectively. In a multivariat...Continue Reading

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Citations

Oct 29, 2003·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Kamyar Kalantar-ZadehJoel D Kopple
Jun 18, 2004·Kidney International·Allen R Nissenson
Jul 31, 2007·Ageing Research Reviews·M Shawkat Razzaque
Jan 18, 2006·Journal of Renal Nutrition : the Official Journal of the Council on Renal Nutrition of the National Kidney Foundation·Julien Bohé, Michael J Rennie
Jun 7, 2003·Cardiology Clinics·Mariell Jessup, Susan C Brozena
Oct 19, 2006·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Raynel Kinney, Raynel Kinney

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