Abstract: TH-OR17
Effect of ESRD Treatment Choices (ETC) on Home Dialysis Utilization Among Incident Dialysis Patients
Session Information
- Dialysis: Patient-Centered Interventions and Outcomes
November 03, 2022 | Location: W414, Orange County Convention Center‚ West Building
Abstract Time: 05:24 PM - 05:33 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Johansen, Kirsten L., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Li, Shuling, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Gilbertson, David T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
- Kou, Chuanyu, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Knapp, Christopher D., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
- Wetmore, James B., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background
The Advancing American Kidney Health Executive Order set ambitious targets for home dialysis in the US. CMS introduced payment models to incentivize home dialysis, including ETC, which launched in January 2021. Although ETC applies only to Medicare fee-for-service (FFS) beneficiaries, it has the potential to change provider behavior for all patients. We examined changes in use of home dialysis among all incident dialysis patients in the US according to provider ETC assignment.
Methods
ESRD providers were randomly assigned to ETC participation at the Hospital Referral Region (HRR) level. Using USRDS data, we analyzed adult patients with incident ESRD who initiated dialysis from January 1, 2016 to March 31, 2022. We excluded patients dialyzing in a SNF or long-term care facility, prior transplant, or missing provider ZIP code. We examined the percentage of patients on home dialysis by ETC participation from first quarter (Q1) 2016 to Q1 2022 and used a changepoint method to assess whether there was a change in the differences between ETC and non-ETC markets during this period.
Results
In total, 766,055 patients were studied (31% ETC participants). Before the assignment of ETC markets in late Q3 2020, the proportion of patients started on home dialysis was increasing steadily but was slightly lower among patients in ETC markets than among those in non-ETC markets (Figure). A changepoint was found just prior to Q4 2020 (p=0.004 for before-after Q4 2020). After this time, home dialysis use increased among patients in ETC markets but not among those in non-ETC markets. After the launch of ETC, a higher percentage started home dialysis in ETC markets (15.4% vs. 14.5%).
Conclusion
The ETC payment model for Medicare FFS beneficiaries appears to have affected practice patterns for all incident dialysis patients. After its introduction, the proportion of patients starting home dialysis continued to increase in ETC markets and flattened in non-ETC markets.
Funding
- NIDDK Support