Original InvestigationDialysisEarly Trends From the Study to Evaluate the Prospective Payment System Impact on Small Dialysis Organizations (STEPPS)
Section snippets
Study Design
STEPPS is a multicenter prospective observational cohort study of 51 dialysis facilities that are members of SDOs within the United States. An SDO was defined as a dialysis provider that was either a stand-alone facility or part of a chain that included 50 or fewer facilities.
Facility Selection
Potential facilities were identified according to a database that included all free-standing US dialysis facilities that (circa 2006) qualified as SDOs according to the mentioned criteria. All potential facilities (n =
Facility Selection and Facility Characteristics
A schematic illustrating how STEPPS facilities were selected is shown in Fig 1. STEPPS includes a sample of 51 dialysis facilities (∼5% of all SDO facilities in the United States). All were still participating as of June 30, 2011; none had been acquired by a large dialysis organization. Of enrolled facilities, 77% opted fully into the PPS in 2011; most of their patients (mean, 68%) have Medicare as their primary payer, with the next-largest group including those with commercial insurance (mean,
Discussion
STEPPS is a prospective cohort study designed to assess the evolution of care within SDOs during implementation of the PPS. In this early report, we describe the assembly of the STEPPS cohort, examine the representativeness of STEPPS facilities and patients compared to the broader SDO population in the United States, and report on trends in certain aspects of dialytic care during the initial phase of PPS implementation. We observed a modest increase in the use of PD over time. There were more
Acknowledgements
We acknowledge the great efforts and contributions of the site investigators and study participants from the 51 dialysis facilities that are participating in STEPPS; Irene Agodoa and Lei Lei for contributions to the design and implementation of the study; and Wendy Ma and Fangfei Chen for assistance with statistical programming.
Support: Support for STEPPS was provided by Amgen Inc.
Financial Disclosure: Dr Brunelli's spouse is employed by AstraZeneca; he previously served on advisory boards for
References (21)
Financing of end-stage renal disease care: past, present, and future
Adv Ren Replace Ther
(1994)- et al.
Facility-level interpatient hemoglobin variability in hemodialysis centers participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS): associations with mortality, patient characteristics, and facility practices
Am J Kidney Dis
(2011) - et al.
Mortality risk for dialysis patients with different levels of serum calcium, phosphorus, and PTH: the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Am J Kidney Dis
(2008) - et al.
The association of race with erythropoietin dose in patients on long-term hemodialysis
Am J Kidney Dis
(2008) - et al.
Temporal trends in red blood transfusion among US dialysis patients, 1992-2005
Am J Kidney Dis
(2008) - et al.
The DOPPS Practice Monitor for US dialysis care: trends through April 2011
Am J Kidney Dis
(2012) - Pub L no. 92-603. Social Security Amendments of...
A quarter century of Medicare expenditures for ESRD
Semin Nephrol
(2000)Medicare Benefit Policy Manual, CMS Pub no. 100-02, Chapter 11, End Stage Renal Disease, §30.2-30.5 (Revised, 10-28-11)
Medicare Program; end stage renal disease prospective payment system: final rule
Fed Regist
(2010)
Cited by (34)
Health policy, disparities, and the kidney
2015, Advances in Chronic Kidney DiseaseHemoglobin stability and patient compliance with darbepoetin alfa in peritoneal dialysis patients after the implementation of the prospective payment system
2014, Clinical TherapeuticsCitation Excerpt :Patients in this sample had moderate agreement in intrapatient Hb levels in each quarter of the study, and the mean SDs showed that variance was fairly constant within a quarter. Transferrin saturation and ferritin levels were similar to the overall study group and were similar to those reported by Brunelli et al12 in HD patients. Anemia is common among PD patients and most require ESAs to maintain adequate Hb levels.13,14
Peritoneal dialysis: Misperceptions and reality
2014, American Journal of the Medical SciencesCitation Excerpt :Thus, PD, which uses far fewer injectable medications and labor, financially became more attractive to the dialysis facilities. The Study to Evaluate the Prospective Payment System Impact on Small Dialysis Organizations (STEPPS) is a prospective observational cohort study of 1,873 adult HD and PD patients from a sample of 51 SDOs, designed to evaluate trends in care and outcomes over the period of PPS implementation.78 It noted a trend toward greater use of PD in SDOs (from 2.4% to 3.6%; P = 0.09) in the early period of PPS implementation from October 2010 to June 2011.
Payment systems for dialysis and their effects: a scoping review
2023, BMC Health Services ResearchPayment systems for dialysis and their effects: a scoping review
2022, Research SquareMedicare Bundled Payment Policy on Anemia Care, Major Adverse Cardiovascular Events, and Mortality among Adults Undergoing Hemodialysis
2022, Clinical Journal of the American Society of Nephrology
Originally published online January 17, 2013.