Abstract: SA-PO978
Expansion of the ESRD Payment Bundle and Dialysis Facility Closures in the United States
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Norouzi, Sayna, Baylor College of Medicine, Bellaire, Texas, United States
- Zhao, Bo, Baylor College of Medicine, Bellaire, Texas, United States
- Awan, Ahmed A., Baylor college of medicine, Houston, Texas, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Bellaire, Texas, United States
- Ho, Vivian, Baker Institute for Public Policy, Houston, Texas, United States
- Erickson, Kevin F., Baylor College of Medicine, Bellaire, Texas, United States
Background
The inclusion of formerly separately billable injectable medications into the ESRD payment bundle in 2011 led to concerns that some facilities facing higher costs would close, disrupting care delivery and limiting access to care for some patients. We examined whether patients were more likely to be affected by dialysis facility closures after the 2011 payment reform, and whether factors that influence closures changed following te payment reform.
Methods
We identified all patients receiving in-center hemodialysis in the United States between 2005 and 2015 and tracked dialysis facility closures throughout this time period. We used an interrupted time-series regression model to examine immediate and longer-term changes in the odds of being at a facility that closed following enactment of the expanded ESRD payment bundle. We then included interaction terms in a series of logistic regression models to examine whether the associations among selected patient, dialysis facility, and geographic characteristics and facility closures changed after 2011.
Results
Dialysis facility closures were relatively uncommon throughout the study period, ranging from 92 facilities (2.0%) affecting 3,725 patients in 2005 to 32 facilities (0.2%) affecting 797 patients in 2014. In a model where we adjusted for changes over time in patient, geographic, and dialysis facility characteristics, the odds of being affected by a dialysis facility closure did not change significantly immediately after enactment of the expanded ESRD payment bundle. Over time, the odds of being affected by a dialysis facility closure decreased by 18% (OR 0.82; 95% CI 0.81 to 0.84) each year after 2011. Patients who were black and those in rural areas and hospital-based facilities experienced a relative increase in the likelihood of being affected by closures after 2011, while patients who were Hispanic, dual-eligible and at smaller dialysis facilities experienced a relative decrease in the likelihood of being affected by closures after 2011.
Conclusion
We did not find evidence that the 2011 expanded ESRD payment bundle was associated with an increased impact of facility closures on patients receiving outpatient dialysis. However, the likelihood of being affected by facility closures changed for some potentially high risk patient groups.
Funding
- NIDDK Support