Clinical and economic value of performing dialysis vascular access procedures in a freestanding office-based center as compared with the hospital outpatient department among Medicare ESRD beneficiaries

Semin Dial. Sep-Oct 2013;26(5):624-32. doi: 10.1111/sdi.12120. Epub 2013 Aug 30.


Dialysis vascular access (DVA) care is being increasingly provided in freestanding office-based centers (FOC). Small-scale studies have suggested that DVA care in a FOC results in favorable patient outcomes and lower costs. To further evaluate this issue, data were drawn from incident and prevalent ESRD patients within a 4-year sample (2006-2009) of Medicare claims (USRDS) on cases who receive at least 80% of their DVA care in a FOC or a hospital outpatient department (HOPD). Using propensity score matching techniques, cases with a similar clinical and demographic profile from these two sites of service were matched. Medicare utilization, payments, and patient outcomes were compared across the matched cohorts (n = 27,613). Patients treated in the FOC had significantly better outcomes (p < 0.001), including fewer related or unrelated hospitalizations (3.8 vs. 4.4), vascular access-related infections (0.18 vs. 0.29), and septicemia-related hospitalizations (0.15 vs. 0.18). Mortality rate was lower (47.9% vs. 53.5%) as were PMPM payments ($4,982 vs. $5,566). This study shows that DVA management provided in a FOC has multiple advantages over that provided in a HOPD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ambulatory Care Facilities / economics*
  • Cohort Studies
  • Female
  • Humans
  • Kidney Failure, Chronic / economics*
  • Kidney Failure, Chronic / therapy
  • Male
  • Medicare / economics
  • Middle Aged
  • Outpatient Clinics, Hospital / economics*
  • Propensity Score
  • Renal Dialysis / economics*
  • Retrospective Studies
  • Treatment Outcome
  • United States
  • Vascular Access Devices / economics*