Enrollment Growth and Payment Practices for Kidney Dialysis Services
HEHS-96-33: Published: Nov 22, 1995. Publicly Released: Nov 22, 1995.
- Full Report:
Pursuant to a congressional request, GAO reviewed Medicare's End Stage Renal Disease (ESRD) Program, focusing on: (1) ESRD enrollment patterns; (2) the reasons for program enrollment and cost increases; and (3) whether there are separately billable services that should be included in the future composite rate.
GAO found that: (1) ESRD program enrollment has increased at an average annual rate of 11.6 percent since 1978; (2) the major reason for the enrollment increase is due to the increase in ESRD patients age 65 years or older and persons whose primary diagnosis is diabetes or hypertension; (3) advances in technology and the greater availability of dialysis machines have allowed persons that were once not considered to be good candidates for dialysis to be placed on dialysis; (4) decreased patient mortality has also contributed to increased ESRD program enrollment; (5) program costs have increased substantially because of increased ESRD enrollment; and (6) there is no separately billable dialysis-related medical service or supply that is provided frequently enough for inclusion in the new composite rate.