Kidney failure and the federal government / / Committee for the Study of the Medicare End-Stage Renal Disease Program, Division of Health Care Services, Institute of Medicine ; Richard A. Rettig and Norman G. Levinsky, editors

• Pubblicazione: Washington, D.C., : National Academy Press, 1991
• Edizione: 1st ed.
• Descrizione fisica: xiv, 426 p. : ill
• Disciplina: 362.1/9614/00973
• Soggetto topico: Chronic renal failure - Government policy - United States; Medicare
• Altri autori: RettigRichard A LevinskyNorman G <1929-> (Norman George)
• Note generali: Bibliographic Level Mode of Issuance: Monograph
• Nota di bibliografia: Includes bibliographical references and index.
• Nota di contenuto: Kidney Failure and the Federal Government -- Copyright -- Acknowledgments -- Contents -- PART I Overview -- Summary -- THE CONGRESSIONAL CHARGE TO THE INSTITUTE OF MEDICINE -- BASIC ASSUMPTIONS -- ESRD PATIENTS AND THEIR TREATMENT -- ACCESS -- ETHICS -- THE PROVIDER COMMUNITY -- REIMBURSEMENT AND QUALITY -- Reimbursement Effects on Quality -- Outpatient Dialysis Reimbursement Issues -- Covered Services -- Rate-Setting and Payment Policy -- QUALITY ASSESSMENT AND ASSURANCE -- DATA SYSTEMS -- RESEARCH -- NOTES -- REFERENCES -- 1 Introduction -- THE CONGRESSIONAL CHARGE -- BASIC ASSUMPTIONS -- CONTEXT OF THIS STUDY -- STUDY METHODS -- THE ESRD PATIENT POPULATION -- NATIONAL EXPENDITURES FOR ESRD -- ORGANIZATION OF THE REPORT -- NOTES -- REFERENCES -- PART II Patients and Providers -- 2 Perspectives of ESRD Patients -- EXPERIENCES WITH RENAL FAILURE -- Patient Relationships with Physicians and Staff -- Patient Education -- Patient-Related Services -- Effect of Erythropoietin -- ECONOMIC EFFECTS OF KIDNEY FAILURE -- CONCLUSIONS -- NOTE -- REFERENCE -- 3 Ethical Issues -- PATIENT ACCEPTANCE CRITERIA -- WITHDRAWAL FROM TREATMENT -- Guidelines -- Advance Directives -- TREATING THE PROBLEM PATIENT -- CONCLUSIONS AND RECOMMENDATIONS. -- NOTES -- REFERENCES -- 4 The Patient Population -- INCIDENCE AND PREVALENCE -- COMPOSITION OF THE ESRD POPULATION -- MORTALITY ISSUES -- Unadjusted Mortality -- Adjusted Mortality -- Subgroup Mortality -- STATE AND REGIONAL MORTALITY DATA -- CROSS-NATIONAL MORTALITY DATA -- PROJECTIONS TO THE YEAR 20006 -- NOTES -- REFERENCES -- 5 The ESRD Patient Population: Special Groups -- PEDIATRIC PATIENTS -- ELDERLY ESRD PATIENTS -- DIABETIC PATIENTS -- HYPERTENSIVE PATIENTS -- Hypertension in the United States -- Relationship Between Hypertension and Hypertensive ESRD -- Epidemiology of ESRD Attributed to Hypertension. ; Intervention -- MINORITY PATIENTS -- CONCLUSION -- NOTES -- REFERENCES -- 6 Structure of the Provider Community -- OVERVIEW -- Outpatient Dialysis Facilities -- Kidney Transplant Centers -- Pediatric Facilities -- CHANGING STRUCTURE OF THE OUTPATIENT DIALYSIS COMMUNITY -- Hospital-Based Versus Independent Providers9 -- Hospital-Based Providers -- Patients -- Independent Providers -- Outpatient Dialysis Facilities -- Not-For-Profit Versus For-Profit Providers11 -- Not-For-Profit Providers -- For-Profit Providers -- Size of Outpatient Dialysis Facilities12 -- Facility Ownership -- CONCLUSIONS -- NOTES -- REFERENCES -- PART III Access -- 7 Access Problems of ESRD Patients -- ESRD PATIENTS NOT ELIGIBLE FOR MEDICARE -- Who Are the Reported Noneligibles? -- Magnitude of the Problem -- Geographic Variations -- Payment Sources -- State Medicaid Programs -- State Kidney Programs -- Other ESRD Programs -- Conclusions and Recommendations -- MEDICARE-ELIGIBLE ESRD PATIENTS -- Pediatric Patients -- Elderly Patients -- Barriers to Access -- Information -- Insurance -- Transportation -- Rehabilitation Services -- Preventive Services -- STATE REGULATIONS -- Specific Limits to Access and Geographic Variations -- Implications of Regulations for Access and Quality -- NOTES -- REFERENCES -- 8 Access to Kidney Transplantation -- OVERVIEW -- THE MEDICARE KIDNEY TRANSPLANT BENEFIT -- DISTRIBUTION OF KIDNEY TRANSPLANTS -- SUPPLY OF DONOR ORGANS -- CONCLUSIONS AND RECOMMENDATIONS -- NOTES -- REFERENCES -- PART IV Reimbursement and Quality -- 9 Medicare ESRD Payment Policy -- KIDNEY TRANSPLANT SERVICES -- Renal Transplant Center Reimbursement -- Physician and Medication Reimbursement -- OUTPATIENT DIALYSIS SERVICES -- Facility Reimbursement -- Historical Overview -- Current Policy -- Special Provisions for Home Dialysis. ; Special Provisions for Recombinant Human Erythropoietin (EPO) -- Physician Reimbursement -- INPATIENT DIALYSIS SERVICES -- Hospital Reimbursement -- Physician Reimbursement -- NOTES -- REFERENCES -- 10 Reimbursement Effects on Quality -- EFFECTS OF REIMBURSEMENT ON MORTALITY -- Assessing the Effects of Reimbursement on Mortality -- EFFECTS OF REIMBURSEMENT ON HOSPITALIZATION -- EFFECTS OF REIMBURSEMENT ON UNIT STAFFING -- What Factors Are Causing These Changes? -- What Are the Consequences of These Staffing Changes? -- Nurses -- Technicians -- Social Workers -- Dietitians -- Implications of Changing Staff Patterns for Quality -- EFFECTS OF REIMBURSEMENT ON INNOVATION -- Hemodialysis -- Peritoneal Dialysis -- Dialysis Research Support -- SUMMARY -- CONCLUSIONS -- NOTES -- References -- 11 Outpatient Dialysis Reimbursement Issues -- COVERED SERVICES IN THE COMPOSITE RATE -- THE RATE-SETTING PROCESS -- Timeliness of Cost Data -- Sampling Versus the Universe -- Medicare Part A Cost Principles -- The Calculation of Cost per Treatment -- Oversight of the Rate-Setting Process -- FACILITY PAYMENT POLICY ISSUES -- Level of Payment -- Dual Composite Rate -- Rebasing and Updating -- Inflation (or Market Basket) -- Patient Complexity (Case Mix) -- Technological Advances and Productivity -- Methods for Rebasing and Updating -- Labor Portion of the Composite Rate -- PHYSICIAN PAYMENT POLICY ISSUES -- CONCLUSIONS AND RECOMMENDATIONS -- NOTES -- REFERENCES -- APPENDIX 1 -- APPENDIX 2 -- Dissenting View of C.R. Neu -- Note -- 12 Quality Assessment and Assurance -- PRINCIPLES OF QA -- THINKING ABOUT QUALITY -- Structure -- Process -- Outcomes -- Outcomes and Process and Structure -- Proximate Clinical Indicators -- Functional-and Health-Status Assessments -- Patient Satisfaction -- Quality of Life -- Adjustment for Patient Complexity. ; RESPONSIBILITIES OF FEDERAL AGENCIES -- Public Health Service -- Centers for Disease Control -- Food and Drug Administration -- National Institutes of Health -- Agency for Health Care Policy and Research -- Health Care Financing Administration -- Conditions of Coverage -- State Survey Process -- HSQB and the ESRD Networks -- Bureau of Policy Development -- Office of Research and Demonstrations -- Coordination Within HCFA -- Quality Assessment and Assurance Data Needs -- CONTINUOUS QUALITY IMPROVEMENT -- The Dialysis Facility: Practical Considerations -- Examples of ESRD Quality Assurance -- CONCLUSIONS AND RECOMMENDATIONS -- NOTES -- REFERENCES -- APPENDIX 1 QUALITY OF CARE IN ESRD: AN EXAMPLE OF A PROXIMATE CLINICAL INDICATOR -- Treating Anemia in Dialysis Patients1 -- Potential Use as an Outcome Indicator -- Potential Use as Process Indicators -- NOTE -- References -- APPENDIX 2 EXAMPLES OF ESRD QUALITY ASSURANCE -- Dialysis Clinic, Inc., Cincinnati (DCI-C) -- Greenfield Health Systems -- National Medical Care, Inc. (NMC) -- Reference -- PART V Data And Research -- 13 Data Systems -- HEALTH CARE FINANCING ADMINISTRATION -- U.S. RENAL DATA SYSTEM -- UNITED NETWORK FOR ORGAN SHARING -- NATIONAL END-STAGE RENAL DISEASE REGISTRY -- ADEQUACY OF DATA SYSTEMS -- RECOMMENDATIONS -- NOTES -- REFERENCES -- 14 Research Needs -- REFERENCES -- APPENDIXES -- A Glossary -- B Acronyms and Initialisms -- C Commissioned Papers and Contractor Reports -- Intergovernmental Health Policy Project, George Washington University -- Medical Media Associates, Inc. -- Urban Institute -- D Survival Analysis Methods for the End-Stage Renal Disease (ESRD) Program of Medicare -- GENERAL ISSUES IN SURVIVAL ANALYSIS -- Overview -- Examples -- Identification of the Study Population -- The Importance of a Comparison Group -- Biased Comparisons. ; Interpreting Standard Errors for Population Data -- Accounting for Random Variation -- Important Versus Significant -- Analysis of Provider Versus Patient -- Choice of Parameter for Mortality Summaries -- Type I and Type II Error Issues -- Projections and Extrapolations -- Accuracy of Counts -- ADJUSTING MORTALITY ANALYSES FOR PATIENT CHARACTERISTICS -- Patient Characteristics Related to Mortality -- Currently Available Data -- Unavailable or Difficult-to-Evaluate Data -- Multivariable Methods -- Stratification -- Modeling -- Simultaneous Effects of Variables -- Constraints on the Adjustment Process -- STATISTICAL METHODS OF ANALYSIS FOR ESRD MORTALITY DATA -- Descriptive Parameters for One Group -- Death Proportions -- Death Rates -- Survival Curves -- Expected Lifetimes -- Comparative Parameters -- Regression Models -- Specific Models and Methods -- Poisson Regression for Death Rates -- Cox Models for Relative Rates and Survival Functions -- Logistic Regression for the Probability of Death -- Conditional Logistic Regression and Sampling from the Risk Set -- Fully Parametric Models -- Prevalent Versus Incident Cohort Analyses -- Frailty -- Treatment Modality -- Publication of Standard Death Rates -- Institutional Characteristics -- Internal and External Standardization -- INTERNATIONAL COMPARISONS -- Limitations -- Etiology -- Age -- Withdrawal Rates -- Patient Follow-up -- Directions for Further Research -- REFERENCES -- E Institute of Medicine ESRD Study Committee Public Hearing, May 5, 1989, Chicago, Illinois -- List of Participants -- F Institute of Medicine ESRD Study Committee Public Hearing on ''Issues in Dialysis Reimbursement Reimbursement Rate-Setting -- List of Participants -- G Institute of Medicine ESRD Study Committee Workshop on ESRD Staffing, November 3, 1989, Washington, D.C. -- List of Participants. ; H Institute of Medicine ESRD Study Committee Workshop on Kidney Transplantation, December 13, 1989, Washington, D.C.
• Sommario/riassunto: Since 1972, many victims of endstage renal disease (ESRD) have received treatment under a unique Medicare entitlement. This book presents a comprehensive analysis of the federal ESRD program: who uses it, how well it functions, and what improvements are needed. The book includes recommendations on patient eligibility, reimbursement, quality assessment, medical ethics, and research needs. Kidney Failure and the Federal Government offers a wealth of information on these and other topics: The ESRD patient population. Dialysis and transplantation providers. Issues of patient access and availability of treatment. Ethical issues related to treatment initiation and termination. Payment policies and their relationship to quality of care. This book will have a major impact on the future of the ESRD program and will be of interest to health policymakers, nephrologists and other individual providers, treatment site administrators, and researchers.
• Titolo autorizzato: Kidney failure and the federal government
• ISBN: 9786610203987; 9781280203985; 1280203986; 9780309597692; 0309597692; 9780585155609; 0585155607
• Formato: Materiale a stampa
• Livello bibliografico: Monografia
• Lingua di pubblicazione: Inglese
• Record Nr.: 9910974429203321
• Lo trovi qui: Univ. Federico II