Abstract: FR-PO469
Understanding the Impact of the Kidney Care Choices (KCC) Model on Utilization and Cost of Care
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
- Ullman, Darin F., The Lewin Group, Falls Church, Virginia, United States
- Negrusa, Brighita Mona, University of Michigan, Ann Arbor, Michigan, United States
- Hirth, Richard A., University of Michigan, Ann Arbor, Michigan, United States
- Dahlerus, Claudia, University of Michigan, Ann Arbor, Michigan, United States
- Lewis, Sarah E., Center for Medicare and Medicaid Innovation, Baltimore, Maryland, United States
- Bacon, Kelsey Roberts, The Lewin Group, Falls Church, Virginia, United States
- Maillet, Annalise, The Lewin Group, Falls Church, Virginia, United States
- Shahinian, Vahakn, University of Michigan, Ann Arbor, Michigan, United States
- Segal, Jonathan H., University of Michigan, Ann Arbor, Michigan, United States
- Wiens, Jennifer, The Lewin Group, Falls Church, Virginia, United States
Background
The Kidney Care Choices (KCC) Model implements provider incentives designed to delay the onset of end-stage renal disease, better prepare patients for dialysis, coordinate care across settings, and increase kidney transplantation. Nephrology practices could join the Kidney Care First (KCF) model option or could combine with transplant providers and other partners such as dialysis facilities to form a Kidney Contracting Entity (KCE) and join the Comprehensive Kidney Care Contracting (CKCC) model option. This study evaluated how this voluntary model affects Medicare payments and utilization, particularly for modalities of dialysis care.
Methods
Using a difference-in-differences (DiD) approach, we estimated the effect of the KCC Model on outcomes relative to a comparison group from before the model (2017–2019) to the Model’s first performance year (PY) (2022). For both model options, the comparison group selection process focused on nephrology practices, with separate comparison groups created for CKCC and KCF model options. We evaluated changes in utilization, Total Medicare Parts A & B payments, and service-specific payments. The sample consisted of 293,491 KCC patients (KCF=23,580; CKCC=269,911) and 138,264 comparison patients (KCF comparison=17,997; CKCC comparison=120,267) across the entire study period. KCC Participants (25 KCFs and 53 KCEs) represented 2,856 nephrology professionals and KCE partnerships included 2,217 dialysis facilities and 133 transplant providers.
Results
In KCF, home dialysis (peritoneal dialysis or home hemodialysis) rose by 2.1 percentage points (pp) (p<0.05), or 2% in relative terms. In CKCC, peritoneal dialysis increased by 0.74 pp (p<0.10), or 8%. CKCC had an increase in home dialysis training (0.15 pp [p<0.01], or 32%). Kidney transplant active waitlisting increased by 1.8 pp (p<0.01), or 15%, for CKCC. General utilization measures, such as hospitalizations and emergency department use, were unaffected. KCF home dialysis payments increased by $45 per patient per month (p<0.01).
Conclusion
Overall, the KCC Model showed some promising effects in its first year, including increased home dialysis use and active transplant waitlisting.
Funding
- Other U.S. Government Support