OBJECTIVES: In-center HD (ICHD) registered nurse (RN) staff to patient (RN:Pt) ratios are commonly as high as 1:9 and home dialysis (PD or HHD) ratios 1:15. Newer dialysis technologies, like the Tablo® Hemodialysis System (Tablo), have sensor-based automation and remote monitoring which may facilitate safer care and improve staff efficiency by reducing technology associated burden, allowing licensed professionals to manage patients more efficiently. We modeled potential increases in patient census and reimbursement by implementing new dialysis technology with existing staff.

METHODS: We developed a dialysis reimbursement model to estimate the impact of two staffing practices: a traditional clinic (TC) assuming RN:Pt ratios of 1:9 and 1:15 for ICHD and home, respectively, and a high-efficiency clinic (HEC) that assumes RN:Pt ratios of 1:15 and 1:25 for ICHD and home. We used the TC RN:Pt ratios to determine maximum patient life-years that could be supported by 4 ICHD and home RN FTEs each. The same RN staffing (4 FTE each) was used to estimate the HEC’s additional census opportunity. The model assumes a 6-day/week, 3-shift/day schedule, payor mix of 50% Medicare, 30% Medicare Advantage (MA), 20% Commercial insurance, and a mix of 50% ICHD or self-care, 25% HHD and 25% PD. Other staff needs (PCT, SW, RD) were assumed equal.

RESULTS: In the TC model, RN staffing was estimated to support 120 annual patient life-years averaging $6.22M in annual reimbursement. The same FTEs in an HEC increased the maximum clinic census by 66.7% to 200 annual patient life-years, averaging a 66.6% increase in annual reimbursement to $10.36M.

CONCLUSIONS: The enhanced safety and monitoring capabilities of newer dialysis technology like Tablo can facilitate high-efficiency staffing models that materially impact providers' ability to keep pace with a growing patient population and sustainably grow self-care and home during persistent nursing shortages.