End-stage kidney disease (ESKD) accounts for a sizable proportion of Medicare spending. Peritoneal dialysis remains an underutilized treatment modality for ESKD despite its quality of life and cost-saving benefits. Medicare policy on reimbursements and patient eligibility for dialysis coverage has been amended numerous times since its inception in 1972. Over the last two decades, Medicare policy on ESKD reimbursements has evolved from a primarily fee-for-service model to a prospective payment system, and within the past few years, it has begun including more experimental payment structures. While prior work has explored the evolution of Medicare’s ESKD policy as a whole, we specifically outline the impact of Medicare policy changes on peritoneal dialysis reimbursement rates, uptake by physicians and dialysis facilities, and accessibility to patients. This narrative review offers historical insights, an overview of modern ESKD policy, actionable strategies, and policy opportunities to increase the accessibility of this treatment modality.

中文翻译：

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美国腹膜透析的政策和支付决定：回顾

终末期肾病 (ESKD) 占医疗保险支出的相当大比例。尽管腹膜透析可以提高生活质量并节省成本，但它仍然是一种未得到充分利用的 ESKD 治疗方式。自 1972 年推出以来，关于报销和患者透析保险资格的医疗保险政策已进行了多次修订。在过去的二十年中，关于 ESKD 报销的医疗保险政策已从主要的按服务付费模式发展为未来的支付系统，并且在过去的几年里，它已经开始包括更多实验性的支付结构。虽然之前的工作已经探讨了 Medicare 的 ESKD 政策的整体演变，但我们特别概述了 Medicare 政策变化对腹膜透析报销率、医生和透析设施的采用以及患者可及性的影响。这篇叙述性回顾提供了历史见解、现代 ESKD 政策概述、可行的策略以及增加这种治疗方式的可及性的政策机会。