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Costs of chronic kidney disease. USRDS 2008 Annual Data Report. Patient & cost distributions for CKD, diabetes, & congestive heart failure, 2006 Figure 5.1 (Volume 1).

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Costs of chronic kidney disease

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Costs of chronic kidney disease

USRDS 2008

Annual Data Report


Patient & cost distributions for CKD, diabetes, & congestive heart failure, 2006Figure 5.1 (Volume 1)

Medicare: period prevalent patients, age 65 & older, without ESRD. Medstat & Ingenix i3: period prevalent patients, age 50–64, enrolled in a fee-for-service plan, & without ESRD. CHF, diabetes, & CKD determined from claims, & costs are for calendar year 2006.


Patient & cost distributions for CKD, diabetes, & congestive heart failure, 2006Figure 5.1 (Volume 1)

Medicare: period prevalent patients, age 65 & older, without ESRD. Medstat & Ingenix i3: period prevalent patients, age 50–64, enrolled in a fee-for-service plan, & without ESRD. CHF, diabetes, & CKD determined from claims, & costs are for calendar year 2006.


Expenditures for CKD, by datasetFigure 5.2 (Volume 1)

Medicare: period prevalent general Medicare patients age 65 & older, with Medicare as primary payor, & not enrolled in Medicare Advantage. Medstat: period prevalent patients age 50–64, enrolled in a fee-for-service plan. CHF, diabetes, & CKD determined from claims.


Overall PPPM costs for CKD, by datasetFigure 5.3 (Volume 1)

Medicare: period prevalent general Medicare patients age 65 & older, with Medicare as primary payor, & not enrolled in Medicare Advantage. Medstat: period prevalent patients age 50–64, enrolled in a fee-for-service plan. CHF, diabetes, & CKD determined from claims. Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire cost-year follow-up time.


Per person per month CKD expenditures, by diagnosis & datasetFigure 5.4 (Volume 1)

Medicare: period prevalent general Medicare patients age 65 & older, with Medicare as primary payor, & not enrolled in Medicare Advantage. Medstat: period prevalent patients age 50–64, enrolled in a fee-for-service plan. CHF, diabetes, & CKD determined from claims. Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire cost-year follow-up time.


PPPM costs during the transition to ESRD, by datasetFigure 5.5 (Volume 1)

Medicare: patients age 67 & older, initiating ESRD therapy in 2005, & with Medicare as primary payor (not enrolled in Medicare Advantage). Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire transition period. Medstat: patients younger than 65, initiating ESRD therapy in 2005, & enrolled for the entire transition period.


PPPM inpatient costs during the transition to ESRDFigure 5.6 (Volume 1)

Medicare: patients age 67 & older, initiating ESRD therapy in 2005, & with Medicare as primary payor (not enrolled in Medicare Advantage). Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire transition period. Medstat: patients younger than 65, initiating ESRD therapy in 2005, & enrolled for the entire transition period.


PPPM cardiovascular hosp. costs during the transition to ESRDFigure 5.7 (Volume 1)

Medicare: patients age 67 & older, initiating ESRD therapy in 2005, & with Medicare as primary payor (not enrolled in Medicare Advantage). Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire transition period. Medstat: patients younger than 65, initiating ESRD therapy in 2005, & enrolled for the entire transition period. Hospitalization cause determined using principal diagnosis code for all groups.


PPPM inpatient/outpatient net costs ($) for CKD, 2006Table 5.a (Volume 1)

Medicare: period prevalent general Medicare patients age 65 & older, with Medicare as primary payor, & not enrolled in Medicare Advantage. Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire cost-year follow-up time. Medstat: period prevalent patients age 50–64, enrolled in a fee-for-service plan. CHF, diabetes, & CKD determined from claims, & PPPM costs are for calendar year 2006, with actuarial categories determined by place of service; CPT, revenue, & HCPCS codes; & provider specialty. Oral prescription drugs (not present for Medicare) are included in the outpatient pharmacy category.


PPPM physician/supplier net costs ($) for CKD, 2006Table 5.a (Volume 1) (continued)

Medicare: period prevalent general Medicare patients age 65 & older, with Medicare as primary payor, & not enrolled in Medicare Advantage. Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire cost-year follow-up time. Medstat: period prevalent patients age 50–64, enrolled in a fee-for-service plan. CHF, diabetes, & CKD determined from claims, & PPPM costs are for calendar year 2006, with actuarial categories determined by place of service; CPT, revenue, & HCPCS codes; & provider specialty. Oral prescription drugs (not present for Medicare) are included in the outpatient pharmacy category.


Per person per month inpatient & outpatient net costs for CKD, by datasetFigure 5.8 (Volume 1)

Medicare: period prevalent general Medicare patients age 65 & older, with Medicare as primary payor, & not enrolled in Medicare Advantage. Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire cost-year follow-up time. Medstat: period prevalent patients age 50–64, enrolled in a fee-for-service plan. CHF, diabetes, & CKD determined from claims, & PPPM costs are for calendar year 2006, with actuarial categories determined by place of service; CPT, revenue, & HCPCS codes; & provider specialty. Oral prescription drugs (not present for Medicare) are included in the outpatient pharmacy category. populations: CKD, diabetes, & CKD determined from claims. Costs are PPPM inpatient plus outpatient costs, & do not include skilled nursing facility, home health, or hospice.


Per person per month physician/supplier net costs for CKDFigure 5.9 (Volume 1)

Medicare: period prevalent general Medicare patients age 65 & older, with Medicare as primary payor, & not enrolled in Medicare Advantage. Dually-enrolled: a subset of the Medicare population; includes patients dually-enrolled for the entire cost-year follow-up time. Medstat: period prevalent patients age 50–64, enrolled in a fee-for-service plan. CHF, diabetes, & CKD determined from claims, & PPPM costs are for calendar year 2006, with actuarial categories determined by place of service; CPT, revenue, & HCPCS codes; & provider specialty. Oral prescription drugs (not present for Medicare) are included in the outpatient pharmacy category. CKD, diabetes, & CKD determined from claims. Costs are PPPM physician/supplier.


Actual & predicted costs per member per month for Medicare CKD patients, by age & diagnosis: MalesTable 5.b (Volume 1)

prevalent general Medicare patients, not enrolled in an HMO, without ESRD, & surviving in 2005. Medicare payments in 2006 include inpatient, skilled nursing, home health, outpatient, physician/supplier, & durable medical equipment. Diagnosis groups based on M+C risk adjustment model (see www.cms.gov). Actual PPPM cost not weighted by follow up time. Definitions for CKD, diabetes, & CHF are based on the CMS-HCC model, i.e., defined if there is any diagnosis code. HCC: hierarchical condition category.


Actual & predicted costs per member per month for Medicare CKD patients, by age & diagnosis: FemalesTable 5.b (Volume 1) (continued)

prevalent general Medicare patients, not enrolled in an HMO, without ESRD, & surviving in 2005. Medicare payments in 2006 include inpatient, skilled nursing, home health, outpatient, physician/supplier, & durable medical equipment. Diagnosis groups based on M+C risk adjustment model (see www.cms.gov). Actual PPPM cost not weighted by follow up time. Definitions for CKD, diabetes, & CHF are based on the CMS-HCC model, i.e., defined if there is any diagnosis code. HCC: hierarchical condition category.


Actual & predicted costs per member per month for Medicare CKD patients, by age & diagnosis: AllTable 5.b (Volume 1) (continued)

prevalent general Medicare patients, not enrolled in an HMO, without ESRD, & surviving in 2005. Medicare payments in 2006 include inpatient, skilled nursing, home health, outpatient, physician/supplier, & durable medical equipment. Diagnosis groups based on M+C risk adjustment model (see www.cms.gov). Actual PPPM cost not weighted by follow up time. Definitions for CKD, diabetes, & CHF are based on the CMS-HCC model, i.e., defined if there is any diagnosis code. HCC: hierarchical condition category.


Annualized actual costs for Medicare CKD patients, 2006Figure 5.10 (Volume 1)

prevalent general Medicare patients, not enrolled in an HMO, without ESRD, & surviving in 2005. Medicare payments in 2006 include inpatient, skilled nursing, home health, outpatient, physician/supplier, & durable medical equipment. Diagnosis groups based on M+C risk adjustment model (see www.cms.gov). Actual PPPM cost not weighted by follow up time. Definitions for CKD, diabetes, & CHF are based on the CMS-HCC model, i.e., defined if there is any diagnosis code. HCC: hierarchical condition category.


Annualized predicted costs for Medicare CKD patients (2007 CMS-HCC model), 2006Figure 5.11 (Volume 1)

prevalent general Medicare patients, not enrolled in an HMO, without ESRD, & surviving in 2005. Medicare payments in 2006 include inpatient, skilled nursing, home health, outpatient, physician/supplier, & durable medical equipment. Diagnosis groups based on M+C risk adjustment model (see www.cms.gov). Actual PPPM cost not weighted by follow up time. Definitions for CKD, diabetes, & CHF are based on the CMS-HCC model, i.e., defined if there is any diagnosis code. HCC: hierarchical condition category.


Ratios of AAPCC & HCC predicted PPPM costs to actual PPPM costs in Medicare CKD patientsTable 5.c (Volume 1)

prevalent general Medicare patients, not enrolled in an HMO, without ESRD, & surviving in 2005. Medicare payments in 2006 include inpatient, skilled nursing, home health, outpatient, physician/supplier, & durable medical equipment. Diagnosis groups based on M+C risk adjustment model (see www.cms.gov). Actual PPPM cost not weighted by follow up time. Definitions for CKD, diabetes, & CHF are based on the CMS-HCC model, i.e., defined if there is any diagnosis code. HCC: hierarchical condition category.


Predicted costs per person per month for Medicare CKD patients: 2006 CMS-HCC vs. 2007 CMS-HCC modelFigure 5.12 (Volume 1)

1: Non-CKD 2: CKD (NDM, non-CHF) 3: CKD + DM 4: CKD + CHF 5: CKD + DM + CHF

prevalent general Medicare patients, not enrolled in an HMO, without ESRD, & surviving in 2005. Medicare payments in 2006 include inpatient, skilled nursing, home health, outpatient, physician/supplier, & durable medical equipment. Diagnosis groups based on M+C risk adjustment model (see www.cms.gov). Actual PPPM cost not weighted by follow up time. Definitions for CKD, diabetes, & CHF are based on the CMS-HCC model, i.e., defined if there is any diagnosis code. HCC: hierarchical condition category.


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