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Kidney Week

Abstract: SA-PO719

A Census of Skilled Nursing Facility Utilization in Medicare Dialysis Patients

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Kubisiak, Kristine, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Ray, Debabrata, NxStage Medical, Inc., Victoria, Minnesota, United States
  • Collins, Allan J., NxStage Medical, Inc., Victoria, Minnesota, United States
  • Weinhandl, Eric D., NxStage Medical, Inc., Victoria, Minnesota, United States
Background

The size of the dialysis patient population that resides in a skilled nursing facility (SNF), either for short-term rehabilitation or long-term custodial care, is unclear. Medicare Part A covers SNF care only in specific circumstances, thus complicating interpretation of Medicare claims analysis. However, Yun et al (Health Serv Outcomes Res Methodol, 2010) proposed an algorithm that collects data from Part A claims for SNF care and Part B claims for physician visits in a SNF to identify Medicare beneficiaries who reside in a SNF. We implemented this algorithm in Medicare dialysis patients to identify an ongoing census of SNF utilization.

Methods

We analyzed data from the United States Renal Data System. For each calendar month from January 2013 to September 2015, we identified patients who underwent outpatient dialysis and carried Medicare Parts A and B as primary payer. According to the algorithm proposed by Yun et al, we ascertained 3 classes of claims among these patients: (1) Medicare Parts A claims submitted by a SNF; (2) Medicare Part B claims submitted by physicians, with place of service code 31 (SNF), 32 (nursing facility), or 33 (custodial care facility); (3) Medicare Part B claims submitted by physicians, with a Current Procedural Terminology code indicating evaluation or management of a nursing facility patient. In each calendar month, we estimated the percentage of patients residing in a SNF, and further classified patients as short-term or long-term residents.

Results

Monthly counts of Medicare dialysis patients increased from approximately 306,600 patients during the first quarter of 2013 to approximately 315,600 patients during the third quarter of 2015. The mean percentage of Medicare dialysis patients residing in a SNF during a month was 8.57%, with a range from 8.24% to 8.90%. Concurrently, the mean percentage of patients residing in a SNF for short-term care was 4.91%, whereas the mean percentage of patients residing in a SNF for long-term care was 3.66%. In the subset of patients with age ≥75 years, the mean percentage of patients residing in a SNF during a month was 14.85%, with 8.70% in a SNF for short-term care and 6.16% in a SNF for long-term care.

Conclusion

During any month, slightly more than 85 of every 1000 Medicare dialysis patients reside in a SNF, with a ratio of approximately 4 to 3 for short-term versus long-term care.

Funding

  • Commercial Support