Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model
The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social r...
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| Published in: | JAMA : the journal of the American Medical Association Vol. 331; no. 2; p. 124 |
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| Main Authors: | , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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09.01.2024
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| ISSN: | 1538-3598, 1538-3598 |
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| Abstract | The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model.
To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk.
A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021.
Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics.
Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization.
Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001).
In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties. |
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| AbstractList | The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model.
To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk.
A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021.
Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics.
Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization.
Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001).
In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties. The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model.ImportanceThe End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model.To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk.ObjectiveTo examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk.A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021.Design, Setting, and ParticipantsA cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021.Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics.ExposureComposition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics.Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization.Main Outcomes and MeasuresUse of home dialysis, waitlisting, or transplant; model performance score; and financial penalization.Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001).ResultsUsing data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001).In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties.ConclusionsIn the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties. |
| Author | Wilk, Adam S Patzer, Rachel E Kim, Daeho Koukounas, Kalli G Rivera-Hernandez, Maricruz Drewry, Kelsey M Meyers, David J Trivedi, Amal N Thorsness, Rebecca Mehrotra, Rajnish |
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| SubjectTerms | Aged Black or African American - statistics & numerical data Black People - statistics & numerical data Cross-Sectional Studies Female Healthcare Disparities - economics Healthcare Disparities - ethnology Healthcare Disparities - statistics & numerical data Hispanic or Latino - statistics & numerical data Humans Kidney Failure, Chronic - economics Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - ethnology Kidney Failure, Chronic - therapy Kidney Transplantation - statistics & numerical data Male Medicaid - economics Medicaid - statistics & numerical data Medically Uninsured - statistics & numerical data Models, Economic Reimbursement, Incentive - economics Reimbursement, Incentive - statistics & numerical data Renal Dialysis - economics Renal Dialysis - methods Renal Dialysis - statistics & numerical data Self Care - economics Self Care - methods Self Care - statistics & numerical data Social Determinants of Health - economics Social Determinants of Health - ethnology Social Determinants of Health - statistics & numerical data United States - epidemiology Vulnerable Populations - statistics & numerical data Waiting Lists |
| Title | Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model |
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