Abstract: SA-PO976
ESRD Quality Incentive Program Payment Reductions, Mortality, Utilization, and Cost
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
- Young, Eric W., 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
- Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background
The ESRD Quality Incentive Program (QIP) adjusts Medicare payments to dialysis facilities based on their performance on a set of quality measures. We assessed whether the magnitude of ESRD QIP payment reductions was associated with several important patient outcomes that are largely not an intrinsic part of the QIP measure set.
Methods
We compared mortality, utilization of healthcare services and Medicare payments per patient-year during 2015-2017 for facilities in each ESRD QIP payment reduction category corresponding to their QIP performance for the same year. The patient cohort consisted of Medicare fee-for-service beneficiaries receiving chronic dialysis for ESRD on the first day of each year. Patients were attributed to the first facility that provided treatment during the year. The data sources include Medicare claims and enrollment files. Descriptive findings were confirmed with regression models that adjusted for patient factors (age, sex, race, ethnicity, diabetes, duration of ESRD and dual eligibility).
Results
Most patients were treated in facilities that did not receive an ESRD QIP payment reduction (Table). There was a stepwise increase in rates of mortality, hospitalization, hospital days and Medicare payments per year in facilities with successively larger payment reductions. The increase in Medicare payments was largely for inpatient services. All findings were statistically significant in adjusted regression models.
Conclusion
Mortality, utilization and Medicare payments were substantially higher for patients treated in facilities whose contemporaneous performance on ESRD QIP measures resulted in a payment reduction. Moreover, these outcome measures increased stepwise with the magnitude of facility payment reductions. The findings are consistent with the hypothesis that the ESRD QIP measures and scoring system capture meaningful determinants of healthcare quality and value.
Patient Outcomes vs. Facility QIP Payment Reduction
| ESRD QIP Payment Reduction | ||||||
| 0% | 0.5% | 1.0% | 1.5% | 2.0% | ||
| Patient Years | 763,902 | 163,635 | 42,808 | 9,437 | 2,949 | |
| Mortality (%/Yr) | 15.6% | 16.3% | 17.3% | 21.2% | 24.5% | |
| Utilization (per Pt-Yr) | Hospitalizations | 1.63 | 1.93 | 2.04 | 2.34 | 2.44 |
| Hospital Days | 10.85 | 13.10 | 14.36 | 17.96 | 20.91 | |
| Payments (per Pt-Yr) | Total | $75,285 | $79,729 | $82,090 | $94,446 | $99,810 |
| Inpatient | $24,761 | $28,678 | $30,701 | $37,560 | $40,881 | |
Funding
- Other U.S. Government Support