Dialysis Costs Higher for Commercial Payers Than Medicare

Employer-sponsored commercial plans paid substantially more for hemodialysis than Medicare did between 2012 and 2019, according to findings published in JAMA Network Open.

“Recent proposals have sought to limit the amount dialysis clinics charge private payers, but little is known about the prices that private insurers actually pay for dialysis,” wrote Riley J League, MA, department of economics, Duke University, and coauthors.

In the cross-sectional study, authors analyzed 1,987,439 medical claims from more than 55 million beneficiaries covered by employer-sponsored plans in the United States. Data was retrieved from the Health Care Cost Institute and spanned 44 states and the District of Columbia.

Between 2012 and 2019, private plans paid an average of $1287 and a median of $1476 per dialysis session, while the highest Medicare base rate was $240, “less than one-sixth the median private price,” authors noted.

“Even the highest possible rate paid by Medicare after case-mix and geographic adjustments in this period ($1081) was 26.8% lower than the median price paid by private insurers,” researchers said.

Dialysis costs also increased by 22.7% for private plans vs .3% for Medicare’s base rate and 1.4% for the maximum adjusted Medicare payment.

Prices among commercial payers also varied widely. The average price for a dialysis session ranged from $950 in Arkansas to $1791 in West Virginia. Researchers reported 2.4% and 1.1% of claims involved costs greater than $2000 and $3000, respectively.

“Lowering the prices paid by private insurers to Medicare rates and discouraging steering patients onto private plans could bring about substantial savings in spending on hemodialysis,” authors concluded.

Reference:
League RJ, Eliason P, McDevitt RC, Roberts JW, Wong H. Variability in prices paid for hemodialysis by employer-sponsored insurance in the US from 2012 to 2019. JAMA Netw Open. 2022;5(2):e220562. doi:10.1001/jamanetworkopen.2022.0562