Economic Gains with Implementation of a Fluid Management Quality Initiative

San Diego—According to data from the US Renal Data System, there are more than 100,000 new hemodialysis patients per year. For patients initiating hemodialysis, the first 90 days are associated with increased rates of hospitalization and mortality, in addition to high healthcare costs.

Melissa M. Rosen, MPH, PhD, and colleagues recently conducted an economic analysis of data on incident hemodialysis patients; the data were gathered as part of a fluid management quality improvement (QI) project using relative blood volume monitoring (RBV-M). The researchers reported results during a poster session at Kidney Week 2018 in a poster titled Estimated Revenue Gains Associated with Relative Blood Volume Monitoring (RBV-M) in Hemodialysis (HD) Clinics: An Economic Model Using Real-World Data and a Case Size of 12 Medicare Incident Patients.

The QI project was conducted at nine Renal Research Institute clinics; RBV-M was performed using Crit-Line® monitors. There was an association between the QI project and an average of 5.3 fewer hospital days and an estimated reduction of 2.5 missed treatments per year in the 1068 incident hemodialysis patients included in the analysis. A cost minimization model from a facility level perspective was used to calculate revenue gains related to fewer missed treatments. The model assumed that hemodialysis clinics continuously served 12 Medicare beneficiaries with two monitors and disposable supplies associated with RBV-M. It was also assumed that patients received three hemodialysis treatments per week and hemodialysis treatments were reimbursed at $350 per patient, the standard Medicare reimbursement amount plus the onset of dialysis adjustment.

For clinics implementing a fluid management initiative with RBV-M, there is the potential of generating additional revenue from reducing 2.5 missed treatments per year. After accounting for the cost of monitors and disposable supplies, this translated into gains of $2048 per year per clinic (with 12 Medicare incident patients) in the implementation year. Once the machines are paid for (either in the second year of the QI project or if the facility already owns the monitors), the annual gains are $6048, including the cost of disposable supplies. Possible savings associated with averted hospitalizations or other benefits of the Q1 project are not included in the savings calculations.

“RBV-M QI initiatives have the potential to reduce missed treatments in incident patients and increase revenue in  hemodialysis clinics. Assuming a reimbursement of $350 per dialysis treatment and 12 incident patients per clinic, potential revenue gains associated with RBV-M were found to be $2048 in the start year and $6048 in the year following implementation (or for clinics who already own monitors). Future cost-effectiveness studies of fluid management initiatives should consider the additional value gained from including prevalent hemodialysis patients who are also likely to benefit from RBV-M,” the researchers said.

Source: Rosen MM, Li Y, Ficociello, Balter P, et al. Estimated revenue gains associated with relative blood volume monitoring (RBV-M) in hemodialysis (HD) clinics: An economic model using real-world data and a case size of 12 Medicare incident patients. Abstract of a poster (TH-PO284) presented at the American Society of Nephrology Kidney Week 2018, October 25, 2018, San Diego, California.

Funding for the analysis was provided by Fresenius Medical Care Renal Therapies Group.