The Medicare end-stage renal disease (ESRD) program costs more than $2 billion a year. Costs per treatment vary significantly across hemodialysis facilities, yet the relationship of these cost differentials to case mix and outcomes is uncertain. This study analyzed treatment variations in 527 chronic hemodialysis patients dialyzing in four freestanding and three hospital-based facilities. Results indicated that patients receiving care in the hospital-based units received a more costly routine dialysis treatment as well as more intensive nursing care during the treatment process than did patients in freestanding units. Policy and clinical implications of the findings are discussed.
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