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Abstract: PO1347

Understanding the Transition to Standardized Fistula Rate (SFR) and Long-Term Catheter Rate (LTCR) Measures in the Medicare ESRD Quality Incentive Program (QIP)

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Wang, Dongyu, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Kapke, Alissa, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Adeleye, Adebola O., Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
  • Houseal, Delia, Centers for Medicare and Medicaid Services, Baltimore, Maryland, United States
  • Young, Eric W., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

In ESRD QIP Payment Year (PY) 2021, vascular access measures change to the SFR and LTCR measures. The changes involve transition of the data source from Medicare claims (CLM) to CROWNWeb (CW), expansion from Medicare fee-for-service (M-FFS) to all ESRD patients, revised numerator criteria (e.g. multiple access types), expanded patient exclusions (e.g. limited life expectancy), and case-mix adjustment for SFR.

Methods

The degree of concordance in reporting vascular access type reported in CLM and CW was assessed and trends in arteriovenous fistula use (AVF) and long-term catheter use (LTC) with the CLM-based and CW-based methods were evaluated from calendar year (CY) 2012-2019. Facilities’ performance rates for the CW-based measures were calculated using PY20 data and compared to their PY20 performance for the CLM-based measures.

Results

The degree of reporting concordance between CLM and CW was high for fistula use (κ=0.95; p<0.01) and slightly lower for catheter use (κ=0.76; p<0.01). The agreement of all access types increased from 90% in CY12 to 97% in CY18. National trends in vascular access were consistently worse for CW-based measures, although this gap narrowed over time (Figure). PY20 data indicate facilities achieved a lower median SFR by 0.8% (vs. CLM-based AVF rate) and higher median LTCR by 1.4% (vs. CLM-based LTCR); however, accompanying changes to performance standards (using baseline data) result in simulated ESRD QIP measure scores increasing by approximately 0.5 points.

Conclusion

Vascular access reporting concordance in CLM and CW improved considerably in CY 2018, which corresponds to the first year of use in the ESRD QIP. The CW-based vascular access performance rates were worse than CLM-based rates; these differences are primarily attributed to the poorer performance of non-FFS patients included in the CW-based measures. While the new vascular access measures have worse performance rates, average ESRD QIP measure scores increase slightly.

AVF (Left) and LTC (Right) National Trends based on CW and CLM Reporting

Funding

  • Other U.S. Government Support