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CMAJ Open. 2020 Feb 18;8(1):E96-E104. doi: 10.9778/cmajo.20190132. Print 2020 Jan-Mar.

Association between change in physician remuneration and use of peritoneal dialysis: a population-based cohort analysis.

Author information

1
Department of Internal Medicine (Trachtenberg), University of Manitoba, Winnipeg, Man.; Departments of Community Health Sciences (Quinn, Ma, Hemmelgarn, Tonelli, Faris, Weaver, Au, Zhang, Manns) and Medicine (Hemmelgarn, Tonelli, Manns), and Libin Cardiovascular Institute of Alberta and O'Brien Institute for Public Health (Hemmelgarn, Tonelli, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Alberta Health Services (Faris), Calgary, Alta.
2
Department of Internal Medicine (Trachtenberg), University of Manitoba, Winnipeg, Man.; Departments of Community Health Sciences (Quinn, Ma, Hemmelgarn, Tonelli, Faris, Weaver, Au, Zhang, Manns) and Medicine (Hemmelgarn, Tonelli, Manns), and Libin Cardiovascular Institute of Alberta and O'Brien Institute for Public Health (Hemmelgarn, Tonelli, Manns), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Alberta Health Services (Faris), Calgary, Alta. Braden.Manns@albertahealthservices.ca.

Abstract

BACKGROUND:

Health care payers are interested in policy-level interventions to increase peritoneal dialysis use in end-stage renal disease. We examined whether increases in physician remuneration for peritoneal dialysis were associated with greater peritoneal dialysis use.

METHODS:

We studied a cohort of patients in Alberta who started long-term dialysis with at least 90 days of preceding nephrologist care between Jan. 1, 2001, and Dec. 31, 2014. We compared peritoneal dialysis use 90 days after dialysis initiation in patients cared for by fee-for-service nephrologists and those cared for by salaried nephrologists before and after weekly peritoneal dialysis remuneration increased from $0 to $32 (fee change 1, Apr. 1, 2002), $49 to $71 (fee change 2, Apr. 1, 2007), and $71 to $135 (fee change 3, Apr. 1, 2009). Remuneration for peritoneal dialysis remained less than hemodialysis until fee change 3. We performed a patient-level differences-in-differences logistic regression, adjusted for demographic characteristics and comorbidities, as well as an unadjusted interrupted time-series analysis of monthly outcome data.

RESULTS:

Our cohort included 4262 patients. There was no statistical evidence of a difference in the adjusted differences-indifferences estimator following fee change 1 (0.89, 95% confidence interval [CI] 0.44-1.81), 2 (1.15, 95% CI 0.73-1.83), or 3 (1.52, 95% CI 0.96-2.40). There was no significant difference in the immediate change or the trend over time in peritoneal dialysis use between fee-for-service and salaried groups following any of the fee changes in the interrupted time-series analysis.

INTERPRETATION:

We identified no statistical evidence of an increase in peritoneal dialysis use following increased fee-for-service remuneration for peritoneal dialysis. It remains unclear what role, if any, physician payment plays in selection of dialysis modality.

Conflict of interest statement

Competing interests: Braden Manns held an unrestricted grant from Baxter from 2014 to 2017, outside the submitted work. No other competing interests were declared.

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