Abstract: SA-PO980
Comprehensive Kt/V Measurement in the Medicare ESRD Quality Incentive Program: Including More Facilities and Recent Improvements in Pediatric and Home Dialysis
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
- Kapke, Alissa, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Hanslits, Katherine, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Houseal, Delia, Centers for Medicare and Medicaid Services, Woodlawn, Maryland, United States
- Szymanski, Amanda, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Leichtman, Alan B., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Young, Eric W., Arbor Research, Ann Arbor, Michigan, United States
Background
In prior Payment Years (PY), facilities primarily treating pediatric patients were often excluded from QIP dialysis adequacy measures for not treating 11 or more eligible patients. In the PY19 QIP, to include more facilities treating pediatric patients, CMS introduced a Comprehensive Kt/V measure combining age groups and modalities.
Methods
Trends in Comprehensive Kt/V were retrospectively assessed using Medicare claims and CROWNWeb data from 2012-2018. Comparisons of Kt/V QIP scores among facilities eligible for the measure in PY19 to those eligible in the prior year used publicly available Performance Score Summary Reports. Pediatric facilities were defined as having more than 50% of period prevalent patients <18 years old; home dialysis facilities were defined as having more than 50% of period prevalent patients on home HD or PD.
Results
The national average Kt/V QIP score in PY19 was 8.0, an increase of 0.6 points over PY18. However, the average Kt/V score was lower for facilities newly eligible for the measure in PY19 compared to facilities eligible in both PY19 and PY18 (5.8 vs. 8.2). For pediatric facilities, the average score in PY19 was 4.0 (N=47), compared to 7.6 (N=8) in PY18. For home dialysis facilities, the average PY19 score was 5.6 (N=409), compared to 6.9 (N=287) in PY18. Performance rates for Comprehensive Kt/V were lowest among pediatric patients, but improved since initial data collection in July 2012 (Figure).
Conclusion
The change to the Comprehensive Kt/V measure in PY19 resulted in the inclusion of more pediatric and home dialysis facilities and lower Kt/V scores for these subgroups. Increases in Comprehensive Kt/V performance rates improved among pediatric PD and home dialysis patients in 2017 and 2018.
Comprehensive Kt/V rates over time by age and modality
Funding
- Other U.S. Government Support