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| Research
> Economic Aspects |
Data sources
Per member per month (PMPM) costs were calculated using the HCFA Standard Analytical Files (SAF). The SAFs included Inpatient Institutional, Outpatient Institutional, Part B – Physician / Supplier, Durable Medical Equipment (DME), Home Health Agency, Skilled Nursing, and Hospice for 1996. Modality sequences were derived from the REBUS data files.
We also provide thematic maps which indicate per member per month (pmpm) costs for all ESRD, all dialysis, hemodialysis, peritoneal dialysis, and transplant, by state and Health Service Area. PMPM costs for diabetic and non-diabetics are also provided.
Methods
Patients were enrolled in the study based on the modality of ESRD therapy on 1/1/96. Each modality change that occurred during the calendar year 1996 resulted in re-enrollment of the patient with the new modality. All patients with Medicare as secondary payer status were excluded because it is impossible to accurately calculate the costs for these patients. Any claims appearing in any of the SAFs with primary payment amounts greater than zero were taken as evidence of Medicare as secondary payer status. For patients who were under 65 years of age and incident after 10/2/95 were censored for 90 days after the first ESRD service date. Transplant patients who were under 65 years of age were censored at three years of graft survival.
Cost categories were based on the DRG for Inpatient Institutional claims, on revenue codes combined with CPT and HCPCS codes for Outpatient Institutional claims, and on CPT and HCPCS codes combined with place of service and specialty codes for Part B and DME claims. All costs associated with Skilled Nursing, Home Health and Hospice claims were placed in their own separate categories. Claims were assigned to patient-modality combinations based on the "from date" of the claim, with the exception of transplant event claims (DRG 302), which were assigned only to the transplant modality based on both the from date and through date of the inpatient claim. Time at risk was calculated for each modality, based on the starting and ending dates of the modality, with start dates set to 1/1/96 for modalities spanning the start of 1996 and end dates set to 1/1/97 for modalities spanning the end of 1996. Per member per month costs (PMPM) were calculated as total cost divided by months at risk.
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