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Abstract: FR-PO511

Low Dialysis Patient Volume in Many Skilled Nursing Facilities: An Obstacle to Improved Outcomes

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Weinhandl, Eric D., Chronic Disease Research Group, Minneapolis, Minnesota, United States
  • Hellebrand, Alice, Dialyze Direct, Neptune City, New Jersey, United States
  • Bellin, Eran Y., Albert Einstein College of Medicine, Bronx, New York, United States
  • Kaufman, Allen, Dialyze Direct, Neptune City, New Jersey, United States

Approximately 15% of dialysis patients are admitted to a skilled nursing facility (SNF) each year. These high-acuity patients represent a challenge to SNFs, as most facilities lack on-site clinical expertise in this domain. In other medical and surgical domains, maintenance of quality requires adequate volume, thus offering ongoing experience to providers. Nothing is known about the volume of dialysis patients in individual SNFs. We analyzed Medicare fee-for-service claims to quantify the experience of SNFs who have admitted at least one dialysis patient during one recent quarter of the pandemic era.


We analyzed 100% of Medicare Parts A and B claims during the first quarter of 2021. We identified patients who received outpatient dialysis during the quarter, and subsequently ascertained all Part A claims for SNF care during the quarter. We estimated the distribution of dialysis patient placements per SNF with ≥1 placement. We also grouped SNFs into core-based statistical areas (CBSAs), according to ZIP code, and calculated distributions of SNFs per CBSA.


We identified 289,858 dialysis patients in the first quarter of 2021, among whom 21,053 (7.3%) received Medicare-covered care in a SNF. These patients were placed in 7858 SNFs. The median number of dialysis patient placements per SNF was 2, with a 25th percentile of 1 patient, a 75th percentile of 3 patients, a 90th percentile of 6 patients, and a 95th percentile of 8 patients. The 7858 SNFs were distributed among 821 CBSAs: 177 (21.6%) CBSAs had only 1 SNF in which dialysis patients were placed, 186 (22.7%) had 2; 170 (20.7%) had 3-4; and 288 (35.1%) had ≥5. CBSAs with ≥5 SNFs represented 89.9% of all dialysis patient placements. The 5 largest CBSAs—New York, Los Angeles, Chicago, Dallas, and Houston—had ≥100 SNFs with dialysis patient placements.


Over 75% of SNFs in which Medicare-covered dialysis patients are placed after hospitalization receive ≤3 patients per quarter. This volume is not sufficiently high to sustain expertise, although the large number of SNFs in urban markets offers an opportunity for centralization. On-site dialysis providers with specialized staff and innovative care models, financed by the dialysis process itself and informed by a central organization with amortized resources for quality improvement, can provide local expertise to SNFs.


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