Abstract: SA-PO057
Disparities in Home Dialysis Utilization Among Dual Eligible Medicare Fee-for-Service (FFS) Beneficiaries
Session Information
- Diversity and Equity: Other Research
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Belowich, Emily, Avalere Health, Washington, District of Columbia, United States
- Fagan, Jack, Avalere Health, Washington, District of Columbia, United States
- Parekh, Shalini, Avalere Health, Washington, District of Columbia, United States
- Gooding, Mark John, Avalere Health, Washington, District of Columbia, United States
Background
Since the 2019 Advancing American Kidney Health (AAKH) initiative, the federal government has focused on enhancing prevention and treatment of kidney disease, including introducing new incentives for home dialysis use for patients who require renal replacement therapy. Access to optimal kidney care services influences greater mortality and morbidity rates. We hypothesized that patients with lower socioeconomic status may have lower use of home dialysis due to the nature of what is required to access this dialysis modality (e.g., health literacy, caregiver support, proper home infrastructure).
Methods
We used 100% Medicare Fee-For-Service (FFS) claims data to identify patients with End Stage Renal Disease (ESRD) who received renal replacement therapy (peritoneal dialysis and hemodialysis) excluding beneficiaries who have received a kidney transplant between January 2019 to June 2022. We stratified beneficiaries by Medicaid dual eligibility status.
Results
Between Q1 2019 – Q2 2022, the rate of home dialysis utilization grew from 12.3% to 15.9% across all Medicare FFS beneficiaries. In Q2 2022, 12.0% of 113,226 dual-eligible beneficiaries utilized home dialysis compared to 19.7% of 115,497 non-dual eligible beneficiaries utilizing home dialysis (p<0.01). This difference in utilization was consistent across the period of analysis; the rate of non-dual eligibles utilizing home dialysis was 7.7 percentage points higher than dual eligible beneficiaries in Q1 2019 and 7.4 percentage points higher in Q1 2022.
Conclusion
The AAKH initiative – compounded by the COVID-19 pandemic – served as a catalyst to advancing home dialysis. However, these findings indicate that access to care is still greatly influenced by socioeconomic status, even with policy changes that intentionally aim to close disparity gaps. Future research and policy should seek to identify how disparities in socioeconomic status and associated challenges can be addressed to allow for equitable access to all treatment modalities for ESRD.
Rates of Unique Medicare FFS Patients with a Home Dialysis Service in the Given Quarter
| Strata | Q1 2019 | Q2 2019 | Q3 2019 | Q4 2019 | Q1 2020 | Q2 2020 | Q3 2020 | Q4 2020 | Q1 2021 | Q2 2021 | Q3 2021 | Q4 2021 | Q1 2022 | Q2 2022 |
| All FFS Beneficiaries | 12.3% | 12.5% | 12.7% | 13.0% | 13.4% | 13.4% | 13.9% | 14.1% | 14.7% | 14.8% | 15.2% | 15.4% | 15.9% | 15.9% |
| Not Dual Eligible | 16.4% | 16.5% | 16.8% | 17.2% | 17.6% | 17.5% | 18.0% | 18.2% | 18.8% | 18.8% | 19.1% | 19.3% | 19.9% | 19.7% |
| Medicaid Full/Partial Dual in Any Month of Quarter | 9.0% | 9.2% | 9.4% | 9.6% | 9.9% | 10.1% | 10.5% | 10.6% | 11.0% | 11.2% | 11.4% | 11.6% | 11.9% | 12.0% |