In January 2011, major payment reforms were implemented by the Centers for Medicare and Medicaid Services (CMS) for the treatment of patients with End-Stage Renal Disease (ESRD) on dialysis. These reforms focus on curtailing the rapid spending growth in the population of dialysis patients. The growth was largely due to the high utilization of injectable drugs, especially erythropoietin stimulating agents (ESAs).2 The reforms include prospective bundled payments and pay-for-performance incentives in the effort to curb costs, while still incentivizing quality of care and improving the efficiency of the care delivered. Both the Government Accountability Office (GAO) and the U.S. Congress have requested an evaluation of the effects of the implementation of the ESRD Prospective Payment System (PPS) on patient care. However, the impact on dialysis center efficiency has not been published to date. Our study aim is to evaluate whether the 2011 PPS improved the efficiency of U.S. dialysis centers and to identify which providers demonstrated changes in their efficiency after the PPS implementation. We hypothesized that the new payment system would lead to increased efficiency during the periods immediately following ESRD PPS implementation after centers adapted their cost structure and practice patterns to stricter payment controls and potential penalties for not meeting quality of care standards.
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