Cost, work, reimbursement, and the pediatric nephrologist in the United States Medicare/End-Stage Renal Disease Program

The American Academy of Pediatrics, the American Society of Pediatric Nephrology, and the Renal Physicians Association combined their efforts to perform a survey of the work involved in providing care to children with end-stage renal disease (ESRD). These data document that the work of delivering care to infants and children on dialysis takes longer and is more intense than the care provided to adult patients. These data were presented to the American Medical Association Specialty Society Relative Value Scale Update Committee (RUC) to justify higher payment for pediatric ESRD care using previously developed monthly capitation payment Current Procedural Terminology codes based on patient age. Relative Work Units of 13.25 for infants (0-2 years), 9.13 for children (2-12 years), 6.47 for adolescents (12-19 years), and 5.24 for adults (> 19 years) were recommended by the RUC to Medicare. A suggested description of services for pediatric dialysis patients covered by the monthly capitated payment was developed.