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Abstract: TH-PO331

Physician Attribution of Long-Term Catheter Use: A New Way of Looking at Clinical Performance Measures

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Segal, Jonathan H., University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Naik, Abhijit S., University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Nahra, Tammie A., University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Wang, Mia, University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Gao, Jingya, University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Sleeman, Kathryn, University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
  • Messana, J. M., University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, Michigan, United States
Background

Quality metrics in national ESRD programs are traditionally calculated at the dialysis facility level. With the Medicare Quality Payment Program, there is interest in physician-level metrics that could complement existing facility-level measures without increasing provider reporting burden. Our objective was to develop methodology to attribute patient outcomes to either individual physicians or group practices and then compare long-term catheter (LTC) use at the facility and provider-level.

Methods

We used NPI numbers to determine the single provider who received the Monthly Capitated Payment (MCP) from 2016 Medicare physician supplier claims, and identified hemodialysis (HD) patient months from Medicare dialysis facility claims. A group practice arrangement was inferred if multiple practitioners shared a common Tax Identification Number (TIN) and provided MCP services to a specific patient in the year. The percent of total HD patient-months with a LTC from CROWNWeb was then assigned to a practitioner or group practice.

Results

9307 providers were identified by NPI caring for 338,718 eligible patients. Using NPI alone, 61% of patients were associated with only one MCP practitioner, while using the TIN matching algorithm an additional 33% of patients stayed within a single group practice during 2016 (See Figure). The mean LTC rate of 14.4% at the provider level for 2 of 3 consecutive months was similar to the LTC facility rate of 13.4%. The LTC rate of 9.7% at the provider level for 3 of 3 consecutive months was less sensitive but more specific.

Conclusion

MCP claims can identify the responsible practitioner for a patient’s care during a given month. The TIN matching algorithm may allow development of a low-burden patient attribution paradigm for ESRD practitioner quality metrics. This approach yields similar results as the facility-level measure of LTC use and could help align dialysis facility and MCP practitioner quality initiatives.

Funding

  • Other U.S. Government Support