New Medicare payment model poses challenges for dialysis facilities serving high-risk patients

A new study of more than 2,000 dialysis facilities randomly assigned to a new Medicare payment model aimed at improving outcomes for patients with end-stage renal disease finds that they are providing disproportionate services to high-risk populations. It was found that the use of home dialysis and transplant waiting lists were lower in facilities with a lower number of patients. The number of kidney transplants will decrease. Therefore, these facilities received lower performance scores and reimbursement from Medicare.

Higher rates of non-Hispanic blacks and people starting dialysis while uninsured or on Medicaid were also found to be indicators of lower use of home dialysis, lower transplant waiting lists, and fewer kidney transplants. did.

The study authors’ goal was to determine how this new payment model would impact or harm dialysis facilities that treat high-risk patients. Their analysis suggests that facilities that treat these vulnerable patients may not fare well under the new payment model and may ultimately not have enough funding to stay open and care for their patients. There are concerns about this.

Home dialysis rates in the United States are significantly lower than in other developed countries. Kidney transplantation is considered the best option for most patients with end-stage renal disease.

A new study examined the first year (2021) of the End-Stage Kidney Disease Treatment Selection Model, developed to promote expanded access to home dialysis and kidney transplantation for Medicare beneficiaries. People of any age with this condition are usually covered by Medicare insurance.

Unfortunately, dialysis facilities, including facilities with high proportions of non-Hispanic black or Hispanic patients, patients dually eligible for Medicaid and Medicare, and patients residing in It turned out that they were treating patients with high levels of Highly disadvantaged areas are more likely to be economically penalized under this model. ”

Rachel Patzer, Ph.D., MPH, study co-author, President and CEO of Regenstrief Institute, Leonard Betley Professor of Surgery, Indiana University School of Medicine

The below-average outcomes are likely a result of the socio-economic problems faced by these patients, factors that are beyond the control of the facilities treating them. Recognizing this, CMS added a risk tiering component to its payment model in subsequent years. However, the analysis presented in the paper suggests that this program modification is not sufficient to address the problem.

“In its first year, this payment system disproportionately penalized facilities with high proportions of high-social-risk patients,” said Kari Koukounas, MPH, lead author of the study and a graduate student at Brown University School of Public Health. “As other pay-for-performance programs have done in the past, this model imposed larger penalties in the first year for facilities serving high-risk populations.”

“This is an important finding because dialysis facilities are typically considered to be the medical hub for patients, and facilities that disproportionately serve patients with higher social risk factors are “They may require additional resources and care to support them,” Dr. Patzer noted. “Many of our previous studies have revealed significant racial and socioeconomic disparities in access to optimal kidney failure treatment across the United States. We want to make sure that facilities have more resources to care for these patients, not less.”

Kidney failure disproportionately impacts socially disadvantaged communities due to decades of upstream social determinants of health. The main causes of kidney disease and end-stage renal disease include diabetes, obesity, and high blood pressure.

The research conducted by this multi-institutional research team was funded by the National Institutes of Health’s National Institute on Minority Health and Health Disparities (PIs: Amal Trivedi, MD, MPH, and Rachel Patzer, PhD, MPH). I received it. Dr. Trivedi of Brown University is the study’s senior author. Regenstrief and Kelsey Drewry, Ph.D., M.S., of Indiana University School of Medicine, are co-authors.

The study authors concluded that “their findings, coupled with an increase in penalties of up to 10 percent in the future, support monitoring of the ETC.” [End-Stage Renal Disease Treatment Choices] This model continues to impact dialysis facilities, which disproportionately serve patients with social risk factors, as well as improving outcomes and care among patients treated at these facilities. It also has an impact on inequality. ”