Abstract: FR-PO0522
Dialysis Modality, Adequacy, and the ESRD Quality Incentive Program
Session Information
- Home Dialysis: Clinical Epidemiology
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- El Shamy, Osama, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Shah, Ankur, Brown University, Providence, Rhode Island, United States
- Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
Background
The ESRD Quality Incentive Program includes the Kt/V Dialysis Adequacy measures as a component of a facility’s performance score. This examines the percentage of patients whose delivered dialysis dose meets the specified target thresholds. We explored the impact of HD-only, HD&PD, and PD-only facility status on facility-level QIP performance scores
Methods
7,200 dialysis facilities in the CMS Dialysis Facility and ESRD QIP-Dialysis Adequacy datasets for calendar year 2019 were categorized as HD-only, PD-only, or HD & PD. We compared three outcomes: Comprehensive Achievement Measure Rate (CAMR), Comprehensive Improvement Measure Rate (CIMR) and Comprehensive Measure Score
Results
HD-only facilities achieved the highest performance scores across all measures, followed by HD&PD facilities, with PD-only facilities showing significantly lower performance. All pairwise comparisons were statistically significant, demonstrating differences in achievement of dialysis adequacy targets across treatment modalities
Conclusion
Providing PD adversely affected adequacy achievement scores, potentially resulting in lower CMS reimbursement rates to facilities that provide PD. This could disincentivize HD units from providing PD and serve as a caution for providers considering standalone PD units
Comparison of HD-only, HD & PD, and PD-only facilities’ Kt/V Comprehensive Achievement Measure Rate, Comprehensive Improvement Measure Rate and Kt/V Comprehensive Scores in calendar year 2019
| Group | Weighted CAMR | Weighted CIMR | Weighted Kt/V Comprehensive Score |
| HD-only | 96.5 ± 3.4* | 95.9 ± 4.5* | 8.47 ± 2.05* |
| HD & PD | 95.6 ± 4.1* | 94.6 ± 5.7* | 7.90 ± 2.24* |
| PD-only | 90.2 ± 9.3* | 83.7 ± 16.4* | 5.79 ± 3.54* |
CAMR = Comprehensive Achievement, CIMR = Comprehensive Improvement Measure Rate. Measure Rate, describing the proportion of patient-months where the target HD spKt/Vof 1.2 or PD kT/V of 1.7 is met. The comprehensive scores evaluate whether the achievement or improvement rates meet or exceed the 15th percentile (achievement threshold), below which a facility will get 0 points toward the total performance score, and approaches the 90th percentile (benchmark) of national ESRD facility performance during the baseline period, above which 10 points are awarded. Performances between those two targets yields anywhere from 1 to 9 points. *All pairwise comparisons among HD-only, HD & PD, and PD-only were significantly different (p < 0.001).