End-stage renal diseases and kidney failure affects more than 31 million Americans and more at risk. The purpose of the Affordable Care Act (ACA) is to ensure that all Americans can access affordable health insurance. Health insurance coverage is critical for managing end-stage renal disease mainly because its treatment is very costly. In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) according to the Medicare Improvements for Patients and Providers Act (MIPPA; section 153(b)).
The ACA amended the MIPPA section requiring the CMS to reduce the ESRD bundled (ESRDB) market basket. The ACA does not allow medical providers to increase medical costs for patients with chronic diseases. The MIPPA act of 2008 required the payment of dialysis services through a bundle that groups together dialysis treatment, specific medication, laboratory tests, and supplies related to dialysis treatment. Such financial approaches to control costs are adversely impacting the quality of care. It increases the financial risks for smaller providers with a limited ability to manage the risks compared to larger providers (Swaminathan, Mor, Mehrotra, & Trivedi, 2012).
Providers would respond to this by using the minimum staff-to-patient ratios and also reduce the availability of facilities. The dialysis providers may also respond to bundled payments by reducing the use of costly treatments in bid to cut costs. This could become quite stressful not only to healthcare providers, staff, and patients, but it could also threaten healthcare quality in the US. Even though the economic changes are felt mainly by the smaller health care providers, the impact is far reaching. Research on the intended and intended consequences of the payment reform is therefore critical (Swaminathan, Mor, Mehrotra, & Trivedi, 2012).