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Abstract: FR-OR21

Impact of Medicare Bundled Dialysis Payment on Regional Racial Disparities in Home Dialysis Utilization

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Wang, Virginia, Durham VA Medical Center, Durham VA Medical Center, Durham, NC, US, hospital, Durham, North Carolina, United States
  • Zepel, Lindsay, Duke University, Durham, North Carolina, United States
  • Coffman, Cynthia, Durham VA Medical Center, Durham VA Medical Center, Durham, NC, US, hospital, Durham, North Carolina, United States
  • Diamantidis, Clarissa Jonas, Durham VA Medical Center, Durham VA Medical Center, Durham, NC, US, hospital, Durham, North Carolina, United States
  • Scholle, Sarah Hudson, National Committee for Quality Assurance, Washington, District of Columbia, United States
  • Maciejewski, Matthew L., Durham VA Medical Center, Durham VA Medical Center, Durham, NC, US, hospital, Durham, North Carolina, United States
Background

The 2011 Medicare prospective payment system (PPS) for dialysis modestly increased access to home-based peritoneal dialysis (PD) and home hemodialysis (HHD) treatment modalities. To examine whether racial disparities in home dialysis use (PD and HHD) were affected, we compared regional change in home dialysis use by White and non-White dialysis patients over time.

Methods

We conducted a retrospective cohort study of dialysis facilities offering home dialysis to 1,098,579 patients with end-stage kidney disease (ESKD) in 2006-2016. Health care region was defined as hospital referral regions (HRR). Patients of non-Hispanic Black/African American, Hispanic, non-Hispanic Asian or Pacific Islander, or other race/ethnicity were grouped into a general category of non-White due to small numbers of home dialysis patients and small samples in some HRRs. For each HRR-year, we computed home dialysis utilization rates for White patients by dividing counts of home dialysis users by White users of any dialysis modality. We repeated this procedure to compute rates for non-White patients, and compared these rates using a generalized estimating equation (GEE) model with a negative binomial distribution, adjusting for regional ESKD provider and patient characteristics.

Results

The mean number of facilities offering home dialysis in each HRR increased from 15.6 in 2006 to 22.1 in 2016, with for-profit ownership (79.8% in 2006, 87.1% in 2016) and chain affiliation (82.3% in 2006, 91.7% in 2016) increasing over time. While average regional home dialysis utilization rates increased over time, disparities persisted with White patients having consistently higher home dialysis utilization than non-Whites in every year (19.5% vs. 12.9% in 2006, 26.2% vs. 17.8% in 2016, on average across HRRs). In adjusted analysis, region-level home dialysis use was one-third lower among non-White patients compared to White patients. Home dialysis disparities did not change following the 2011 Medicare payment reform (incidence rate ratio (IRR)=0.97, 95% CI=0.92, 1.02; p=0.29).

Conclusion

Racial disparities in home dialysis use persist after Medicare payment reform despite modest increases in dialysis facility availability and patient utilization. Targeted policy efforts are needed to reduce disparities in the use of home dialysis.

Funding

  • Other U.S. Government Support