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Kidney Week

Abstract: PO1047

Mortality and Cost Track Yearly Changes in ESRD Quality Incentive Program Performance

Session Information

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
  • Jin, Yan, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Houseal, Delia, Centers for Medicare and Medicaid Services, Baltimore, 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

Patients treated in dialysis facilities that receive payment reductions under the ESRD QIP experience higher mortality and cost (Medicare payments) during the same performance year. We asked whether these outcome measures track with yearly changes in the QIP payment reduction.

Methods

Mortality and cost per patient year were analyzed using claims files for dialysis patients enrolled in the traditional Medicare fee-for-service program for performance years 2010-2016.

Results

The table displays index-year mortality and cost (columns) according to the facility QIP payment reduction (PR) for the prior year (rows) and the direction of the change in QIP PR in the index-year (worse, unchanged, better). In almost all cases, mortality and cost were higher for patients in facilities that did worse in QIP and lower for patients in facilities that did better. For example, patients treated in dialysis facilities that received a 1.5% QIP PR in the prior year experienced 18.7% mortality if the index-year PR was unchanged, 16.9% mortality if the index-year PR was lower (<1%) and 24.5% mortality if the index-year PR was higher (2%).

Conclusion

Patient mortality and average Medicare payments track with changes in facility QIP PRs. The finding suggests that facility efforts to improve QIP performance may translate into improved mortality and lower costs to Medicare. Moreover, it is unlikely that the observed association between outcome measures and QIP is attributable to unmeasured patient case-mix, which tends to be relatively stable from year to year. The findings suggest that the ESRD QIP captures meaningful aspects of quality and value.

Prior Year
QIP Payment
Reduction (PR)
Mortality,
by Change in QIP PR
Medicare Payment,
by Change in QIP PR
WorseUnchangedBetterWorseUnchangedBetter
0.0%16.8%15.6%n.a.$79,971$76,227n.a.
0.5%17.1%16.6%16.1%$81,864$81,334$78,384
1.0%21.2%16.3%16.4%$91,018$75,786$79,187
1.5%24.5%18.7%16.9%$91,816$85,555$81,323
2.0%n.a.24.6%19.7%n.a.$98,216$83,957

Funding

  • Other U.S. Government Support