Trends in prevalence of patient case-mix adjusters used in the Medicare dialysis payment system

Christopher S. Hollenbeak, Robert J. Rubin, Spiros Tzivelekis, J. Mark Stephens

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


OBJECTIVES: The Medicare End-Stage Renal Disease Prospective Payment System (PPS) used data from 2006-08 to set weights for each case-mix adjuster that is part of the bundled payment formula. The details of the population case-mix were not made public, and little is known about consistency of case-mix over time. This study estimated the prevalence of case-mix adjusters during 2006-2008 and analyzed changes in case-mix prevalence from 2000-2008.

METHODS: Cross-sectional cohort study using United States Renal Data System data for Medicare dialysis patients. Three 3-year cohorts (2000-02, 2003-05, 2006-08) were analyzed for changes over time in case-mix prevalence.

RESULTS: Double-digit trends were observed in many case-mix categories between 2000-02 and 2006-08. Large declines were observed in prevalence of patients with low BMI, pericarditis, new to dialysis, and ages 18-44. Large increases were observed in chronic co-morbidities, pneumonia and age cohort 80+.

CONCLUSIONS: Substantial changes in case-mix adjuster prevalence suggest the PPS payment formula should be regularly updated.

Original languageEnglish (US)
Pages (from-to)24-7, 31-4
JournalNephrology news & issues
Issue number6
StatePublished - Jun 1 2015

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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