Abstract: SA-PO979
Associations Between Mortality and Payment Reductions Under the Centers for Medicare & Medicaid Services (CMS) ESRD Quality Incentive Program (ESRD 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
- Griffin, Shannon, Insight Policy Research, Arlington, Virginia, United States
- Marr, Jeffrey, Insight Policy Research, Arlington, Virginia, United States
- Breck, Andrew, Insight Policy Research, Arlington, Virginia, United States
- Esposito, Dominick, Insight Policy Research, Arlington, Virginia, United States
- Adeleye, Adebola O., CMS, Woodlawn, Maryland, United States
Background
The implementation of CMS’ ESRD QIP in 2010 introduced financial incentives for certified dialysis facilities to provide high/adequate levels of care. Under the QIP, underperforming dialysis facilities receive a Medicare payment reduction of up to two percent. This study assesses how QIP penalties are associated with 1-year mortality during performance years (PY) and the likelihood of death in the years after each quality assessment.
Methods
We used Medicare claims, enrollment, and CROWNWeb data to examine mortality among outpatient dialysis patients enrolled in Medicare fee-for-service between 2010 and 2017. We used a Cox Proportional-hazards model to measure survival by payment reduction percentage and a difference-in-differences (DD) model to evaluate whether the gap in mortality between penalized and non-penalized facilities changed over time. We adjusted both models using facility and patient characteristics.
Results
Compared to facilities that received no penalty based on 2017 performance, 2017 mortality at penalized facilities was 9% higher (1.091 hazard ratio; p < 0.001). Mortality rates were also higher for facilities that received higher reductions: for PY2017, mortality at a facility with a 2% reduction was about 21% higher than at a facility with no reduction and 7% higher at a facility that received a 0.5% reduction (1.209 and 1.069 hazard ratios, respectively; p < 0.001). Results were similar for PY2010–2016. The difference in probability of death among patients at penalized facilities compared to non-penalized facilities decreased slightly after the performance year by up to 1 percentage point. DD model estimates varied in size and statistical significance across years and amount of time elapsed after each performance year.
Conclusion
Receiving an ESRD QIP payment reduction is correlated with same-year mortality among Medicare fee-for-service dialysis patients, and higher reduction amounts are associated with higher mortality rates. The differences in mortality between penalized and non-penalized facilities persisted after each performance year, though these differences decreased modestly in subsequent years.
Funding
- Other U.S. Government Support