The Role Of Social Risk Factors In Dialysis Facility Ratings And Penalties Under A Medicare Quality Incentive Program

Medicare's End-Stage Renal Disease Quality Incentive Program is a mandatory pay-for-performance program for US dialysis facilities, in which facilities are penalized up to 2 percent of their total Medicare payments based on their performance on quality metrics. While analyses of similar program...

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Bibliographic Details
Published in:Health Affairs 2019-07, Vol.38 (7), p.1101-1109
Main Authors: Qi, Andrew C., Butler, Anne M., Joynt Maddox, Karen E.
Format: Article
Language:English
Subjects:
Bias
Dialysis
End-stage renal disease
Enrollments
Ethnicity
Family income
Fines & penalties
Government programs
Health care policy
Hemodialysis
Hispanic Americans
Incentives
Internet
Kidney diseases
Medicaid
Medicare
Mortality
Patients
Pay for performance
Payments
Penalties
Performance related pay
Postal codes
Public health
Quality
Quality of care
Race
Risk analysis
Risk factors
Urban areas
Variables
Vulnerability
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Summary:Medicare's End-Stage Renal Disease Quality Incentive Program is a mandatory pay-for-performance program for US dialysis facilities, in which facilities are penalized up to 2 percent of their total Medicare payments based on their performance on quality metrics. While analyses of similar programs in other settings have shown performance to be related to social risk factors, it is unknown whether this program displays similar patterns. In this national study, facilities located in low-income ZIP codes and with high proportions of patients who were black or dually enrolled in Medicaid had lower performance scores and higher rates of penalization under the program. Independent (versus chain) status, large facility size, and urban location were also associated with penalties. Further study is needed to determine the degree to which these patterns reflect low-quality care delivery versus patient factors beyond providers' control. In the meantime, the impact of these penalties on providers serving vulnerable populations should be tracked closely.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2018.05406