Kidney Week

Abstract: SA-OR059

Patient Experience with Care as a Critical Component of the Medicare ESRD Quality Incentive Program (QIP)

Session Information

• Hemodialysis Potpourri
  November 09, 2019 | Location: 144, Walter E. Washington Convention Center
  Abstract Time: 04:42 PM - 04:54 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Hanslits, Katherine, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Katherine Hanslits, MPH

Katherine Hanslits works as a research analyst at Arbor Research Collaborative for Health in Ann Arbor, Michigan. She earned her MPH in Epidemiology from University of Michigan School of Public Health in 2017 and her BA in Biology from Barnard College of Columbia University in 2013.

• Griffin, Shannon, Insight Policy Research, Arlington, Virginia, United States

Shannon Griffin,

• Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Jeffrey Pearson,

• Kapke, Alissa, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Alissa Kapke,

• Gaber baylis, Licia, Insight Policy Research, Arlington, Virginia, United States

Licia Gaber baylis,

• Adeleye, Adebola O., CMS, Woodlawn, Maryland, United States

Adebola O. Adeleye,

• Breck, Andrew, Insight Policy Research, Arlington, Virginia, United States

Andrew Breck,

• Esposito, Dominick, Insight Policy Research, Arlington, Virginia, United States

Dominick Esposito,

• Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Marc Turenne,

• Young, Eric W., Arbor Research, Ann Arbor, Michigan, United States

Eric W. Young,

• Leichtman, Alan B., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Alan B. Leichtman,

Background

Medicare has long required dialysis facilities to assess patient experience as a condition for Medicare participation. More recently, the ESRD QIP introduced the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) pay-for-reporting measure in payment year (PY) 2014, shifting to pay-for-performance starting in PY18. The ICH-CAHPS performance measure is based on patient-reported data from 3 global ratings and 3 composite ratings from 35 survey questions.

Methods

We used facility ICH-CAHPS survey results reported in the ESRD QIP Performance Score Summary Reports and CROWNWeb data during 2012-18 to examine facility eligibility and ICH-CAHPS performance from PY14-19. We evaluated ICH-CAHPS performance by facility case-mix and by receipt of payment reduction using linear regression.

Results

In PY18 and 19, <50% of QIP-eligible facilities were scored on ICH-CAHPS. Over 2,200 facilities were not scored due to obtaining <30 complete surveys. Among scored facilities, scores increased slightly from PY18 to PY19; the share of facilities receiving a score of 0 decreased from 8.5% to 4.2%. Performance was highest on the composite “providing information to patients” and lowest on the global rating of nephrologists. Important determinants of low ICH-CAHPS scores included facility case-mix (e.g. patient race and Medicaid eligibility) and ownership by the two large dialysis organizations. On average, facilities with PY19 payment reductions scored 2.5 points lower on ICH-CAHPS in PY19. Similarly, facilities penalized in PY18 had lower ICH-CAHPS scores in PY19.

Conclusion

Patient experience with care is an important component of the CMS Meaningful Measures framework, and by extension, the ESRD QIP. The use of ICH-CAHPS results in the Medicare ESRD QIP was limited to about half of facilities in PY18 and 19; improving survey response rates in moderately sized facilities may include more facilities. Survey results varied by facility case-mix and ownership. QIP-penalized facilities had lower ICH-CAHPS scores in the performance year and the subsequent year.

Funding

• Other U.S. Government Support