Abstract: FR-PO470
Impact of a New Payment Model on Optimal ESKD Starts
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Dahlerus, Claudia, University of Michigan, Ann Arbor, Michigan, United States
- Ullman, Darin F., The Lewin Group, Falls Church, Virginia, United States
- Hirth, Richard A., University of Michigan, Ann Arbor, Michigan, United States
- Negrusa, Brighita Mona, The Lewin Group, Falls Church, Virginia, United States
- Lewis, Sarah E., Center for Medicare and Medicaid Innovation, Baltimore, Maryland, United States
- Segal, Jonathan H., University of Michigan, Ann Arbor, Michigan, United States
- Shahinian, Vahakn, University of Michigan, Ann Arbor, Michigan, United States
- Nahra, Tammie A., University of Michigan, Ann Arbor, Michigan, United States
- Gunden, Joseph, University of Michigan, Ann Arbor, Michigan, United States
- Wiens, Jennifer, The Lewin Group, Falls Church, Virginia, United States
Group or Team Name
- Kidney Epidemiology and Cost Center.
Background
CMS’ Kidney Care Choices (KCC) Model aims to delay ESKD^ onset, better prepare patients for chronic dialysis, and increase kidney transplantation. A nephrology practice can participate under the Kidney Care First (KCF) model option, or, nephrology professionals/practices can partner with transplant providers and other optional partners to form a Kidney Contracting Entity under the Comprehensive Kidney Care Contracting (CKCC) model option. One KCC quality metric is the percentage of patients who have an “optimal ESKD start.” Credit is given for any of the following outcomes: ESKD patients that start on home dialysis; start in-center hemodialysis with a fistula or graft vs. a catheter; or receive a preemptive kidney transplant. We examined the impact of the KCC Model on optimal ESKD starts.
Methods
We used a propensity score matched comparison group and difference-in-differences (DiD) methods to assess trends pre (2017-2019) and post model implementation (2022), adjusted for patient, practice, and market differences. We used CMS claims and the CMS 2728 Form to identify optimal starts for patients aligned to KCF and CKCC participants relative to practice level matched comparison groups. The sample consisted of eligible FFS Medicare beneficiaries with Stage 4 or 5 CKD or ESKD aligned to the KCF and CKCC model options and matched comparison groups during the study period. There were 22,131 KCC and 15,087 comparison patients across the entire study period. Ninety-one percent of patients were aligned to the CKCC option.
Results
While the proportion of patients who had an Optimal ESKD Start increased over time for both KCC and comparison groups, the KCC Model increased Optimal ESKD Starts 6.9 percentage points (p<0.05, 16% of baseline mean) above the baseline trend for beneficiaries aligned to the CKCC option. This impact was driven by increases in home dialysis starts and starting in-center HD with an AV fistula or AV graft. Improvement was not significantly better in the KCF option relative to its comparison group.
Conclusion
Results suggest nephrologists may be able to modify processes of care to improve planned starts for new ESKD patients.
^For the purposes of this abstract, ESKD and ESRD can be used interchangeably. CMS uses ESRD in the KCC Model to be concordant with the ESRD Medicare benefit.
Funding
- Other U.S. Government Support