Economics of Dialysis Access

Dialysis remains an expensive therapy with disproportionately high spending on care of patients with end stage kidney disease. For patients requiring hemodialysis, vascular access serves as a lifeline, but the costs associated with maintaining it remain very high varying with the type of vascular access. To curtail costs and avoid costly hospitalization, vascular access procedures have been increasingly performed in an outpatient setting. In this chapter we discuss economics of dialysis vascular access and describe the three ambulatory settings in which vascular access procedures can be performed. In addition to regulatory and operational differences, significant differences exist in the reimbursement of similar procedures for vascular access tied to the site where these are performed resulting in key financial impact affecting the economic viability of these three different sites. With health care costs in the U.S. on the rise, there has been an increasing focus to transition from fee for service towards value-based care model. By providing key specialty services required in the placement and maintenance of dialysis vascular access in an expeditious and economical way, the ambulatory dialysis access centers will continue to play a critical role in the care of patients on dialysis in any health care model.