Organizational Characteristics Associated with High Performance in Medicare's Comprehensive End‐Stage Renal Disease Care Initiative

• Published in: Health services research 2020-08, Vol.55 (S1), p.5-6
• Main Authors: Drewry, K., Trivedi, A., Wilk, A.
• Format: Article
• Language: English
• Subjects: Beneficiaries; Bivariate analysis; Composition; Enumeration; Family income; Government programs; Hispanic people; Income; Kidney diseases; Medicaid; Medicare; Mortality; National plans; Physicians; Population studies; Regression analysis; Regression models; Special Issue Abstract; Special Issue Abstracts; Statistical analysis
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.13328

Research ObjectiveIn 2016, the 1% of Medicare beneficiaries with end‐stage renal disease (ESRD) constituted > 7% of total Medicare spending ($35 billion). To improve the value of care for the ESRD population, the Centers for Medicare and Medicaid Services (CMS) implemented an alternative payment model (APM) for ESRD care, the ESRD Seamless Care Organization (ESCO). This model shares savings with organizations that reduce spending for their ESRD patients below a defined benchmark. This study evaluated the relationship between key organizational, provider, community characteristics, and ESCO performance.Study DesignWe constructed a novel, linked ESCO‐level data set capturing key information for all 37 Wave 2 (2017) ESCOs. After describing the organizational diversity of 2017 ESCOs, we performed bivariate comparisons of high‐ and low‐performing (eg, above versus below median) ESCOs based on three key outcomes: gross savings/losses, composite quality score, and standardized mortality ratio. Subsequently, we estimated generalized logistic regression models of ESCO performance as a function of organizational (number and type of participating facilities, and beneficiary‐to‐provider ratio), ESCO‐participating provider (credential and specialty), and community (percent Hispanic, non‐Hispanic black, percent Medicaid eligible, and median household income) characteristics.Population StudiedThe 37 ESCOs of 2017 were characterized using information from CMS reports, the National Plan and Provider Enumeration System National Provider Identification registry, and the Area Health Resource File. Combined, these ESCOs represented 40 162 Medicare beneficiaries.Principal FindingsESCO performance on the three outcomes was highly varied (ranges: savings/losses, −3.9% to 10.2%; quality, 76.4% to 100.0%; standardized mortality, 0.75 to 1.14), as were the ESCOs’ characteristics. Bivariate analysis showed that ESCOs with above (vs below) median savings had more aligned physicians (57.8 vs 28.6, P = .06), fewer dialysis facilities (8.66 vs 17.2, P = .07), a smaller non‐Hispanic black population (14.1% vs 21.9%, P = .06), and higher median household income ($55 532 vs $48 952, P < .001). Facilities reporting a composite quality score of 100% (vs