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Breck A, Marr J, Turenne M, Esposito D. The Role of Social Risk Factors in Dialysis Quality and Patient Outcomes Under a Medicare Quality Incentive Program. Med Care 2022; 60:735-742. [PMID: 35880769 DOI: 10.1097/mlr.0000000000001750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There have been critical improvements in dialysis care and mortality in the last decade. These improvements track with the implementation of the end-stage renal disease (ESRD) Quality Incentive Program (QIP) beginning in 2012, which aligns Medicare payments to dialysis facilities with performance on quality measures. This study explores whether the improvements in dialysis care and patient outcomes under the ESRD QIP have been shared equally among patient groups. METHODS Our analyses focus on 4 social risk factors: Black race, Hispanic ethnicity, dual eligibility for Medicare and Medicaid, and rurality. We estimated multivariable regressions using longitudinal Medicare and Consolidated Renal Operations in a Web-Enabled Network data. RESULTS ESRD QIP payment reductions were more common at dialysis facilities with higher proportions of Black and dual-eligible ESRD patients. Patients with dual eligibility and Black race had persistently worse relative outcomes as the ESRD QIP was implemented. This finding was true for differences in outcomes when comparing patients within and across facilities and was not affected by the addition of specific quality measures to the ESRD QIP measure set. Hispanic patients and patients at rural facilities have generally not had worse outcomes since the start of the ESRD QIP. CONCLUSIONS There is no evidence of widening disparities in dialysis care or patient outcomes across patient groups under the ESRD QIP, which is a longstanding and well-publicized concern with value-based purchasing programs. Relative changes between patient groups since the start of ESRD QIP have not favored any patient group. Many disparities in dialysis quality measures and assessment of dialysis facility payment reductions persist.
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Affiliation(s)
| | | | - Marc Turenne
- Arbor Research Collaborative for Health, Ann Arbor, MI
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Taylor K, Crews DC. Toward Antiracist Reimbursement Policy in End-Stage Kidney Disease: From Equality to Equity. J Am Soc Nephrol 2021; 32:2422-2424. [PMID: 34253586 PMCID: PMC8722808 DOI: 10.1681/asn.2021020189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kathryn Taylor
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Deidra C. Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Salerno S, Dahlerus C, Messana J, Wisniewski K, Tong L, Hirth RA, Affholter J, Gremel G, Wu Y, Zhu J, Roach J, Balovlenkov Rn E, Andress J, Li Y. Evaluating national trends in outcomes after implementation of a star rating system: Results from dialysis facility compare. Health Serv Res 2020; 56:123-131. [PMID: 33184854 DOI: 10.1111/1475-6773.13600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine which factors are driving improvement in the Dialysis Facility Compare (DFC) star ratings and to test whether nonclinical facility characteristics are associated with observed longitudinal changes in the star ratings. DATA SOURCES Data were collected from eligible patients in over 6,000 Medicare-certified dialysis facilities from three annual star rating and individual measure updates, publicly released on DFC in October 2015, October 2016, and April 2018. STUDY DESIGN Changes in the star rating and individual quality measures were investigated across three public data releases. Year-to-year changes in the star ratings were linked to facility characteristics, adjusting for baseline differences in quality measure performance. DATA COLLECTION Data from publicly reported quality measures, including standardized mortality, hospitalization, and transfusion ratios, dialysis adequacy, type of vascular access for dialysis, and management of mineral and bone disease, were extracted from annual DFC data releases. PRINCIPAL FINDINGS The proportion of four- and five-star facilities increased from 30.0% to 53.4% between October 2015 and April 2018. Quality improvement was driven by the domain of care containing the dialysis adequacy and hypercalcemia measures. Additionally, independently owned facilities and facilities belonging to smaller dialysis organizations had significantly lower odds of year-to-year improvement than facilities belonging to either of the two large dialysis organizations (Odds Ratio [OR]: 0.736, 95% Confidence Interval [CI]: 0.631-0.856 and OR: 0.797, 95% CI: 0.723-0.879, respectively). CONCLUSIONS The percentage of four- and five-star facilities has increased markedly over a three-year time period. These changes were driven by improvement in the specific quality measures that may be most directly under the control of the dialysis facility.
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Affiliation(s)
- Stephen Salerno
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Claudia Dahlerus
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph Messana
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Karen Wisniewski
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lan Tong
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard A Hirth
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jordan Affholter
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Garrett Gremel
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - YiFan Wu
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Ji Zhu
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jesse Roach
- The Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
| | | | - Joel Andress
- The Centers for Medicare & Medicaid Services, Baltimore, Maryland, USA
| | - Yi Li
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
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Qi AC, Butler AM, Joynt Maddox KE. The Role Of Social Risk Factors In Dialysis Facility Ratings And Penalties Under A Medicare Quality Incentive Program. Health Aff (Millwood) 2019; 38:1101-1109. [DOI: 10.1377/hlthaff.2018.05406] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Andrew C. Qi
- Andrew C. Qi is a medical student at the Washington University School of Medicine, in Saint Louis, Missouri
| | - Anne M. Butler
- Anne M. Butler is an instructor of medicine at the Washington University School of Medicine, in Saint Louis
| | - Karen E. Joynt Maddox
- Karen E. Joynt Maddox is an assistant professor of medicine (cardiology) at the Washington University School of Medicine, in Saint Louis
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Norris KC, Williams SF, Rhee CM, Nicholas SB, Kovesdy CP, Kalantar-Zadeh K, Boulware LE. Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society. Semin Dial 2017; 30:213-223. [PMID: 28281281 PMCID: PMC5418094 DOI: 10.1111/sdi.12589] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
End-stage renal disease (ESRD) is one of the starkest examples of racial/ethnic disparities in health. Racial/ethnic minorities are 1.5 to nearly 4 times more likely than their non-Hispanic White counterparts to require renal replacement therapy (RRT), with African Americans suffering from the highest rates of ESRD. Despite improvements over the last 25 years, substantial racial differences are persistent in dialysis quality measures such as RRT modality options, dialysis adequacy, anemia, mineral and bone disease, vascular access, and pre-ESRD care. This report will outline the current status of racial disparities in key ESRD quality measures and explore the impact of race. While the term race represents a social construct, its association with health is more complex. Multiple individual and community level social determinants of health are defined by the social positioning of race in the U.S., while biologic differences may reflect distinct epigenetic changes and linkages to ancestral geographic origins. Together, these factors conspire to influence dialysis outcomes among African Americans with ESRD.
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Affiliation(s)
- Keith C. Norris
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Sandra F. Williams
- Department of Integrated Medical Science, Florida Atlantic University, Florida
| | - Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
| | - Susanne B. Nicholas
- Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Csaba P. Kovesdy
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California
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