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For-profit dialysis facilities associated with poor patient experience

Patients with end-stage renal disease reported low quality of dialysis care in for-profit, free-standing and largely owned facilities, according to data published in JAMA Internal Medicine.

“Medicare’s End-Stage Renal Disease Quality Incentive Program incorporates measures of perceived value into reimbursement calculations,” Brian M. Brady, MD, from Stanford University School of Medicine, and colleagues wrote. “In 2016, patient experience became a clinical measure in the Quality Incentive Program scoring system. Dialysis facility performance in patient experience measures has not been studied at the national level to date.”

Brady and colleagues conducted a cross-sectional analysis to investigate the associations between dialysis facility performance and patient, facility and geographic characteristics based on patient experience measures. The researchers linked patients with end-stage renal disease receiving in-center hemodialysis to dialysis facility scores on the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey.

A total of 2,939 facilities were included. Compared with their counterparts, adjusted mean ICH-CAHPS scores were lower by 2.6 percentage points (95% CI, 1.5-3.7) in for-profit facilities, lower by 1.6 percentage points (95% CI, 0.9-2.2) in facilities owned by large dialysis organizations and lower by 2.3 percentage points (95% CI, 0.5-4.2) in free-standing facilities.

ICH-CAHPS scores were 0.2 percentage points (95% CI, 0.03-0.3) higher when facilities had more nurses per patient and 1.2 percentage points (95% CI, 0.2-2.2) higher for privately insured patient populations.

Higher proportions of black patients were associated with 0.95 percentage points (95% CI, 0.78-1.12) lower ICH-CAHPS scores and more Native American patients were associated with 1 percentage point (95% CI, 0.39-1.6) lower scores. Between-facility variation in ICH-CAHPS scores were mainly due to geographic location and dialysis facility characteristics rather than patient characteristics.

“Our findings raise concern about perceived patient experiences at for-profit, free-standing dialysis facilities and [large dialysis organizations] and about the perceived quality of care provided to certain racial and ethnic populations. ... These results reveal an opportunity for evaluation-informed policy refinement in the evolution of Medicare payment reform,” Brady and colleagues concluded. – by Alaina Tedesco

Disclosures: Brady reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.