Changes and alternatives for dialysis facilities under the bundled payment plan.

The new prospective payment system, or bundled payment plan, for dialysis treatments presents dialysis providers with the potential for clinical and economic risk and opportunity, depending on the modality of dialysis therapy used and the frequency and doses of injectable drugs administered. Under the bundle, some financial incentives may encourage starting incident patients on home dialysis, either home hemodialysis or peritoneal dialysis. Administration of injectable medications such as vitamin D and iron, which are no longer separately billable, may require providers to consider oral equivalents or slightly different dosing patterns. Treatment of anemia with erythropoiesis-stimulating agents will also require careful consideration, as will use of oral medications when they are added to the bundle in 2016. These factors are already playing out in the marketplace, and going forward providers will need to balance changes in utilization with patient care.