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Abstract: PO1135

Do Dialysis Facilities Improve Quality After Receiving a Penalty Under the ESRD Quality Incentive Program?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Marr, Jeffrey, Insight Policy Research Inc, Arlington, Virginia, United States
  • Breck, Andrew, Insight Policy Research Inc, Arlington, Virginia, United States
  • Griffin, Shannon, Insight Policy Research Inc, Arlington, Virginia, United States
  • Yee, Tracy, Insight Policy Research Inc, Arlington, Virginia, United States
  • Esposito, Dominick, Insight Policy Research Inc, Arlington, Virginia, United States
  • Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Houseal, Delia, Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
  • Adeleye, Adebola O., Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
Background

We examined whether quality measures improve at dialysis facilities penalized under the Centers’ for Medicare and Medicaid (CMS) End-Stage Renal Disease Quality Incentive Program (ESRD QIP) after receipt of a penalty.

Methods

Using data from CMS public use files from payment years (PY) 2014-2017, Medicare claims, and CROWNWeb, we used a difference-in-differences analysis to compare patient level measures of dialysis quality at facilities that did and did not receive penalties before and after the performance period. We also used a regression discontinuity design to compare patient quality measures two years after the performance period at facilities just above and just below ESRD QIP’s performance score penalty threshold.

Results

Patients at penalized facilities had improved dialysis adequacy after the performance periods associated with PY2014-2017 and improved vascular access after the performance period associated with PY2014, compared to patients at nonpenalized facilities. Changes in vascular access after the PY2015 – PY2017 performance periods were not statistically significant. In the 5 years after the performance period associated with PY2014, the percent of patient-months with a fistula in use and the percent of patient-months meeting adult HD Kt/V standard (HD Kt/V ≥1.2) increased by 2.2 percentage points (95% CI 0.9 to 3.4) and 2.9 percentage points (95% CI 1.4 to 4.4), respectively, while the percent of patient-months with a catheter in use decreased by 2.6 percentage points (95% CI -3.7 to -1.5) at penalized facilities compared to nonpenalized facilities.

Compared to those at nonpenalized facilities with relatively similar quality scores, patients at penalized facilities had lower catheter use two years after the PY2014 performance period and higher fistula use two years after the PY2016 performance period. However, these estimates are sensitive to specification changes. Other estimates were not statistically significant.

Conclusion

Receiving an ESRD QIP penalty is associated with subsequent improvements in some measures of dialysis quality, though results differ across payment years and analytic method.

Funding

  • Other U.S. Government Support