14 Dec Facilities that Care For Poor Kidney Failure Patients Can Be Financially Penalized
MedicalResearch.com Interview with:
Rebecca Thorsness, PhD
Department of Health Services, Policy, and Practice
Brown University School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In 2019, the President signed the Advancing American Kidney Health executive order, which included provisions to increase the use of home dialysis and kidney transplant for Americans living with kidney failure. To carry out this vision, the Centers for Medicare & Medicaid Services (CMS) developed the ESRD Treatment Choices (ETC) payment model, which uses financial incentives and penalties to incentivize dialysis facilities to pursue home dialysis or kidney transplant for their patients.
Transplant and home dialysis are optimal care for people with kidney failure, but there are social and clinical reasons that patients with high social risk (such as those exposed to racism, poverty, or housing instability) may not be candidates for these treatments. This means that facilities which serve a large number of patients with high social risk might be disproportionately penalized by this new payment model. Using data immediately prior to the implementation of the ETC model, we found that dialysis facilities that serve high proportions of patients with high social risk have lower rates of home dialysis and kidney transplantation than facilities that care for lower proportions of such patients.
MedicalResearch.com: What should readers take away from your report?
Response: Dialysis facilities that care for patients with high social risk might be disproportionately financially penalized by the ETC payment model. Beginning in 2022, the ETC model will have different performance benchmarks for facilities that serve large proportions of low-income patients. We found that this helps level the playing field for home dialysis rates, but facilities that serve patients with high social risk still have lower kidney transplant rates than those with patients with less social risk, even when performance benchmarks are adjusted for low-income patients.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Facilities that serve patients with high social risk may need more support to overcome the structural barriers to kidney transplant and home dialysis for their patients. Without this support, these facilities may be in danger of closing, which would negatively impact the patients they currently serve. Future research should focus on how dialysis facilities and clinicians can enable and support access to home dialysis and kidney transplant for patients who have historically been excluded from these treatment options. We’d also recommend that CMS should monitor the effects of the ETC model on dialysis facilities that serve patients with greater social risk, and act quickly if the payment model adversely affects the patients who receive care at those facilities
MedicalResearch.com: Is there anything else you would like to add?
Response: CMS’s decision to adjust performance benchmarks for facilities that serve large numbers of low-income patients is an important first step in addressing the role of social and structural determinants of health in payment models. However, low income is not the only social risk factor that affects access to care and patient outcomes.
We have no relevant financial disclosures – just that this study and our findings don’t reflect the policy or position of the US Department of Veterans Affairs or US Government
Thorsness R, Wang V, Patzer RE, et al. Association of Social Risk Factors With Home Dialysis and Kidney Transplant Rates in Dialysis Facilities. JAMA. 2021;326(22):2323–2325. doi:10.1001/jama.2021.18372
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