Abstract: SA-PO977
Dialysis Facilities with Recurring Payment Reductions Under the ESRD Quality Incentive Program (QIP)
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
- Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Ding, Zhechen, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Kapke, Alissa, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Houseal, Delia, Centers for Medicare and Medicaid Services, Woodlawn, Maryland, United States
- Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Young, Eric W., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background
The ESRD QIP is designed to promote quality of care through financial incentives that reward improvement. It is not known whether a lack of improvement in certain aspects of quality may lead some facilities to consistently receive payment reductions under the ESRD QIP. We assessed the extent to which there are facilities continuing to receive payment reductions over time, whether this is more common among certain facility types, and whether this results from lower performance on certain ESRD QIP measures.
Methods
We studied 6,135 dialysis facilities eligible for the ESRD QIP in each payment year (PY) from 2017-19. Data sources include Medicare claims and CROWNWeb. We compared ESRD QIP measure scores among facilities with a payment reduction for 0, 1, 2, or 3 PYs. We used descriptive analyses and Poisson regression to examine factors associated with the number of PYs with a payment reduction.
Results
Among ESRD QIP eligible facilities during 2017-19, 60.5% had no payment reductions, 23.9% had a payment reduction in 1 PY, 10.6% had a payment reduction in 2 PYs, and 5.0% had a payment reduction in all 3 PYs. Payment reductions in all 3 PYs were more common among facilities that are independent (17.5%) or hospital-based (14.3%), treat >100 patients (6.1%), and in ESRD Networks 2 or 7 (13.8% and 11.2%). These findings were statistically significant based on Poisson regression. Facilities with recurring payment reductions had lower average scores for all clinical ESRD QIP measures (Table).
Conclusion
Dialysis facilities that receive recurring payment reductions under the ESRD QIP have lower performance across a range of quality measures. It is important to assess both opportunities and potential challenges for improvement among facilities with recurring payment reductions.
Average facility measure score, ESRD QIP PYs 2017-19
| ESRD QIP Measure or Measure Topic | No. of years with a payment reduction, 2017-19 | |||
| 0 | 1 | 2 | 3 | |
| Kt/V | 8.3 | 7.2 | 6.0 | 4.3 |
| Vascular access type | ||||
| Catheter | 6.2 | 4.7 | 3.9 | 2.7 |
| Fistula | 6.0 | 4.3 | 3.3 | 2.4 |
| Hypercalcemia | 8.3 | 7.7 | 7.1 | 6.3 |
| National Healthcare Safety Network Bloodstream Infection | 5.8 | 5.1 | 4.5 | 3.5 |
| Standardized Readmission Ratio | 5.5 | 4.1 | 3.5 | 3.0 |
| Standardized Transfusion Ratio | 6.1 | 4.6 | 3.9 | 3.2 |
| In-center Hemodialysis Consumer Assessment of Healthcare Providers and Systems | 5.8 | 4.3 | 3.2 | 2.7 |
Funding
- Other U.S. Government Support