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Early winners and losers in dialysis center pay-for-performance

BACKGROUND: We examined the association of dialysis facility characteristics with payment reductions and change in clinical performance measures during the first year of the United States Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease Quality Incentive Plan (ESRD QIP) to...

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Autores principales: Saunders, Milda R., Lee, Haena, Chin, Marshall H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721658/
https://www.ncbi.nlm.nih.gov/pubmed/29216894
http://dx.doi.org/10.1186/s12913-017-2764-4
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author Saunders, Milda R.
Lee, Haena
Chin, Marshall H.
author_facet Saunders, Milda R.
Lee, Haena
Chin, Marshall H.
author_sort Saunders, Milda R.
collection PubMed
description BACKGROUND: We examined the association of dialysis facility characteristics with payment reductions and change in clinical performance measures during the first year of the United States Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease Quality Incentive Plan (ESRD QIP) to determine its potential impact on quality and disparities in dialysis care. METHODS: We linked the 2012 ESRD QIP Facility Performance File to the 2007–2011 American Community Survey by zip code and dichotomized the QIP total performance scores—derived from percent of patients with urea reduction rate > 65, hemoglobin < 10 g/dL, and hemoglobin > 12 g/dL—as ‘any’ versus ‘no’ payment reduction. We characterized associations between payment reduction and dialysis facility characteristics and neighborhood demographics, and examined changes in facility outcomes between 2007 and 2010. RESULTS: In multivariable analysis, facilities with any payment reduction were more likely to have longer operation (OR 1.03 per year), a medium or large number of stations (OR 1.31 and OR 1.42, respectively), and a larger proportion of African Americans (OR 1.25, highest versus lowest quartile), all p < 0.05. Most improvement in clinical performance was due to reduced overtreatment of anemia, a decline in the percentage of patients with hemoglobin ≥ 12 g/dL; for-profits and facilities in African American neighborhoods had the greatest reduction. CONCLUSIONS: In the first year of CMS pay-for-performance, most clinical improvement was due to reduced overtreatment of anemia. Facilities in African American neighborhoods were more likely to receive a payment reduction, despite their large decline in anemia overtreatment.
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spelling pubmed-57216582017-12-12 Early winners and losers in dialysis center pay-for-performance Saunders, Milda R. Lee, Haena Chin, Marshall H. BMC Health Serv Res Research Article BACKGROUND: We examined the association of dialysis facility characteristics with payment reductions and change in clinical performance measures during the first year of the United States Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease Quality Incentive Plan (ESRD QIP) to determine its potential impact on quality and disparities in dialysis care. METHODS: We linked the 2012 ESRD QIP Facility Performance File to the 2007–2011 American Community Survey by zip code and dichotomized the QIP total performance scores—derived from percent of patients with urea reduction rate > 65, hemoglobin < 10 g/dL, and hemoglobin > 12 g/dL—as ‘any’ versus ‘no’ payment reduction. We characterized associations between payment reduction and dialysis facility characteristics and neighborhood demographics, and examined changes in facility outcomes between 2007 and 2010. RESULTS: In multivariable analysis, facilities with any payment reduction were more likely to have longer operation (OR 1.03 per year), a medium or large number of stations (OR 1.31 and OR 1.42, respectively), and a larger proportion of African Americans (OR 1.25, highest versus lowest quartile), all p < 0.05. Most improvement in clinical performance was due to reduced overtreatment of anemia, a decline in the percentage of patients with hemoglobin ≥ 12 g/dL; for-profits and facilities in African American neighborhoods had the greatest reduction. CONCLUSIONS: In the first year of CMS pay-for-performance, most clinical improvement was due to reduced overtreatment of anemia. Facilities in African American neighborhoods were more likely to receive a payment reduction, despite their large decline in anemia overtreatment. BioMed Central 2017-12-08 /pmc/articles/PMC5721658/ /pubmed/29216894 http://dx.doi.org/10.1186/s12913-017-2764-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Saunders, Milda R.
Lee, Haena
Chin, Marshall H.
Early winners and losers in dialysis center pay-for-performance
title Early winners and losers in dialysis center pay-for-performance
title_full Early winners and losers in dialysis center pay-for-performance
title_fullStr Early winners and losers in dialysis center pay-for-performance
title_full_unstemmed Early winners and losers in dialysis center pay-for-performance
title_short Early winners and losers in dialysis center pay-for-performance
title_sort early winners and losers in dialysis center pay-for-performance
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721658/
https://www.ncbi.nlm.nih.gov/pubmed/29216894
http://dx.doi.org/10.1186/s12913-017-2764-4
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