Dialysis Payment Model Reform: Managing Conflicts Between Profits and Patient Goals of Care Decision Making

Dialysis patients represent <1% of all patients served by the US Centers for Medicare & Medicaid Services (CMS), but their treatments account for 7% of all CMS expenditures.1 In 2014, total Medicare spending for beneficiaries with end-stage renal disease (ESRD) was nearly $33 billion. Care of dialysis patients near the end of life is particularly expensive, with median Medicare per-patient costs of $20,731 over the last 30 days of life.1 Dialysis patients are hospitalized on average nearly twice per year and spend about 11 days in the hospital per year.

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