Mortality correlates with ESKD quality incentive program facility payment reductions
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Patient mortality correlated with end-stage kidney disease quality incentive program facility payment reductions in “dose-response” and temporal patterns, according to a retrospective study.
Data published in the Clinical Journal of the American Society of Nephrology, revealed patients experienced higher mortality at each payment reduction level.
“While a mortality measure has not been included in the [End-Stage Renal Disease Quality Incentive Program] ESRD QIP to date, the ESRD QIP’s existing measures aim to capture aspects of facility quality of care that may impact patient mortality. To address some of the concerns about the ESRD QIP’s ability to capture facility quality, we measured the association between patient mortality and ESRD QIP-imposed facility payment reductions,” Shannon M. Griffin, MPP, from Insight Policy Research in Arlington, Virginia, and colleagues wrote.
In this retrospective study, researchers examined data of patients covered by traditional Medicare fee-for service with at least one paid Medicare dialysis claim during the year and dialysis. Researchers measured the correlation between Medicare payment reductions and patient mortality. Based on the year of performance, researchers assessed the relationship between mortality and ESKD QIP facility and expressed it through the unadjusted rate and patient case-mix-adjusted hazard ratio.
Using Cox proportional-hazards models, researchers measured correlation between patient mortality and facility payment reduction category and change in facility payment reduction category from the prior year.
5% to 42% of dialysis facilities resulted from facility performances during the 9 study years. As payment reduction levels progressed, patients experienced increasingly higher mortality. Researchers identified unadjusted mortality of 17.3, 18.1, 18.9, 20.3 and 23.9 deaths per 100 patient-years for patients in facilities receiving 0%, 0.5%, 1%, 1.5% and 2%payment reductions, respectively, across all years.
Between 2010 and 2016, the correlation remained strong. Additionally, patients who received care in facilities and improved during a year experienced lower mortality, whereas patients in facilities that performed worse on ESRD QIP measures experienced higher mortality.
“In summary, we found patient mortality was associated with ESRD QIP payment reduction in a ‘dose-response’ pattern,” Griffin and colleagues wrote. “The association emerged consistently every year from 2010 to 2018. Year-to-year changes in mortality tracked with changes in facility ESRD QIP performance. These findings strongly indicate the ESRD QIP captures meaningful and consequential markers of quality of care delivered by dialysis facilities. However, the ESRD QIP has occasionally received criticism over the inclusion of certain measures. Despite potentially valid criticisms regarding individual measures, our core finding supports the overall validity of the aggregated, composite measure of facility performance. As a separate and independent indicator of quality of care, the analysis of the association between mortality and ESRD QIP performance offers a potentially useful means of tracking the impact and validity of the program.”
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