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Intervention by nephrologists in Stage 4 kidney disease patients could net $1 billion in savings for healthcare systems

Hemodialysis costs Medicare $80,000 per patient yearly; Researchers say use of nephrologist to slow progression could save Medicare $730 million.

Beth Jones Sanborn, Managing Editor


A new analysis from the Rand Corporation indicates giving specialized medical care and coordination to kidney disease patients whose kidneys are failing before they need dialysis could save the U.S. healthcare system more than $1 billion annually.


Nearly one in seven Americans has chronic kidney disease and about 90 percent will ultimately need hemodialysis. That treatment costs Medicare roughly $80,000 annually per patient. In 2015, Medicare spent 20 percent of its budget providing care to patients with chronic kidney disease.


Avoiding kidney dialysis in a hospital setting spawned about 60 percent of the savings.

Researchers focused on Stage 3 and Stage 4 kidney disease patients and looked at examining whether there would be savings from increasing use of nephrologists to slow disease progression and improve coordination of care for patients who undergo kidney transplants.

While results showed increasing nephrology care for Stage 3 patients wouldn't generate net savings, among Stage 4 patients doing so would yield an estimated $1.36 billion in annual savings, including $730 million saved by Medicare.

Previous studies have also shown that patients who saw a nephrologist one to six months before starting dialysis did better, with shorter dialysis-related hospital stays and lower mortality rates over the next five years. However, kidney disease patients aren't referred to nephrologists frequently enough.


"Extending specialized care to patients with advanced kidney disease before their kidneys fail would have benefits both for patients and for the organizations that pay for their health services," said Harry Liu, the study's lead author and a senior policy researcher at Rand, a nonprofit research organization. "But new payment models may be needed to encourage this change."


According to researchers, several newer models of paying for healthcare could help drive the earlier use of nephrology care for patients with advanced kidney disease.

Researchers proposed expanding Medicare's chronic condition special needs plans to cover advanced chronic kidney disease patients. 

"Because these plans are paid on a per-patient basis, they would create financial incentives for providers to improve outcomes and reduce costs, researchers say," the study said.

They also proposed episode-based payments models that would pay providers on a per disease episode basis instead of for each task or procedure.

Twitter: @BethJSanborn
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