eAppendix. Details on the Construction of Data Used in the Study
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League RJ, Eliason P, McDevitt RC, Roberts JW, Wong H. Variability in Prices Paid for Hemodialysis by Employer-Sponsored Insurance in the US From 2012 to 2019. JAMA Netw Open. 2022;5(2):e220562. doi:10.1001/jamanetworkopen.2022.0562
Recent proposals have sought to limit the amount dialysis clinics charge private payers,1 but little is known about the prices that private insurers actually pay for dialysis.2,3 In this study, we provide novel evidence on dialysis prices based on claims data for a large national sample of private employer-sponsored insurance carriers.
In this cross-sectional study, we analyzed data from the Health Care Cost Institute, which included all medical claims for enrollees in employer-sponsored health insurance plans offered by carriers covering more than 55 million individuals per year from 2012 to 2019. We reported summary statistics for the prices paid for hemodialysis claims at the national and state levels over time. We also compared these prices with the prices paid by Medicare for the same service, considering both Medicare’s base rate and the highest and lowest possible adjusted rates. Details on the construction of these data are available in the eAppendix in the Supplement. This study was approved by the institutional review board of Duke University and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. We analyzed the data using Stata, version 16.1 (StataCorp, LLC).
The data included 1 987 439 claims for hemodialysis sessions from 2012 to 2019. The mean and median prices that private insurers paid for a dialysis session in the sample were $1287 and $1476, respectively. For context, the highest Medicare base rate during the sample period was $240, less than one-sixth the median private price. Even the highest possible rate paid by Medicare after case-mix and geographic adjustments in this period ($1081) was 26.8% lower than the median price paid by private insurers. Furthermore, prices paid by private insurers varied substantially across our sample, with an SD of $584 and an IQR of $737 to $1671. We observed 47 535 (2.4%) claims with prices of more than $2000 and 21 835 (1.1%) claims with prices of more than $3000.
From 2012 to 2019, the median price for dialysis paid by private insurers increased from $1349 to $1655 (22.7% growth). By contrast, the Medicare base rate for dialysis rose 0.3%, and the maximum adjusted Medicare payment rose 1.4% (Figure).
The prices paid by private insurers also varied widely across the US. Among the District of Columbia and the 44 states for which we were able to report data, the average price ranged from $950 in Arkansas to $1791 in West Virginia (Table). Our data use agreement prevented us from reporting state-level information based on fewer than 1500 claims or for which the insurer market concentration was high enough that the insurer risked being identified. The 6 states for which we did not report information fell into these categories.
The prices paid by commercial insurers for dialysis are substantially higher than Medicare’s reimbursements and have increased at a much faster rate during the past decade. This pattern suggests that recent proposals seeking to limit the price of dialysis for individuals with private insurance could bring about large spending reductions,2 whereas steering patients from Medicare to private insurance would likely increase spending, a recent concern of policy makers.4
A limitation of this study is that although the data used covered more than 30% of the employer-sponsored insurance market,5 the results may not represent the prices paid by insurers not in the data set or those paid by private payers in other markets, such as Medicare Advantage or the individual market. Lowering the prices paid by private insurers to Medicare rates and discouraging steering patients onto private plans could bring about substantial savings in spending on hemodialysis.
Accepted for Publication: January 10, 2022.
Published: February 28, 2022. doi:10.1001/jamanetworkopen.2022.0562
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 League RJ et al. JAMA Network Open.
Corresponding Author: Riley J. League, MA, Department of Economics, Duke University, 419 Chapel Dr, 211 Social Sciences, Durham, NC 27708 (email@example.com).
Author Contributions: Mr League had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: League, Eliason, McDevitt, Roberts.
Acquisition, analysis, or interpretation of data: League, Eliason, McDevitt, Wong.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: League, Eliason, McDevitt.
Statistical analysis: League, Eliason, McDevitt, Wong.
Obtained funding: McDevitt, Roberts.
Administrative, technical, or material support: McDevitt, Roberts.
Supervision: Eliason, McDevitt, Roberts.
Conflict of Interest Disclosures: Dr Eliason reported receiving grants from the National Science Foundation outside the submitted work. Dr McDevitt reported receiving personal fees from Renalogic for attending advisory board meetings outside the submitted work. Dr Roberts reported receiving grants from the National Science Foundation that helped pay for research assistant work during the conduct of the study. No other disclosures were reported.