Kidney Week

Abstract: FR-PO1028

Switching Back to Medicare Fee-for-Service after 1 Year of Medicare Advantage Coverage among Patients with ESKD

Session Information

• Social, Environmental, and Economic Determinants of Kidney Health
  October 25, 2024 | Location: Exhibit Hall, 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

• Liu, Jiannong, Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

Jiannong Liu, PhD

• Wetmore, James B., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

James B. Wetmore, MD, MS

• Guo, Haifeng, Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

Haifeng Guo, MS

• Gilbertson, David T., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

David T. Gilbertson, PhD

• Roetker, Nicholas S., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

Nicholas S. Roetker, MS, PhD

• Johansen, Kirsten L., Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States

Kirsten L. Johansen, MD, FASN

Background

Medicare beneficiaries with end-stage kidney disease (ESKD) were able to switch from Medicare fee-for-service (MFFS) to Medicare Advantage (MA) starting in 2021. About 11.6% of dialysis patients (pts) and 5.4% of kidney transplant (Tx) pts switched in 2021. This study assessed how many pts switched back to MFFS in 2022, a potential indicator of dissatisfaction with the program.

Methods

We used United States Renal Data System data to identify adult ESKD pts who switched from MFFS to MA in 2021 and survived to 2022. “Switching back” was defined as enrollment in MFFS in January 2022. For comparison, we assessed the rate of switching to MFFS in 2022 among those ESKD pts who were continuously enrolled in MA 2020-2021. Analyses were stratified by ESKD modality.

Results

Among 31,972 pts (27,644 dialysis, 4,328 Tx) who switched from MFFS to MA in 2021, 1.41% of dialysis pts and 1.52% of Tx pts switched back to MFFS in 2022, whereas only 0.50% of dialysis pts and 0.44% of Tx pts switched to MFFS in 2022 among those who were continuously enrolled in MA. Among dialysis pts who switched to MA in 2021, switching back to MFFS was more common among those who were older (2.79% in 75-85 years and 2.92% 85+), Asian (2.50%) or Other race (2.49%), or living in Northeast (2.03%); and less common in younger groups, Black or Hispanic, and Medicare-Medicaid dual enrolled (Table). The pattern was less clear among dialysis pts who were in MA 2020-2021 and among Tx pts.

Conclusion

One year after switching from MMFS to MA in 2021, a small percentage switched back. However, the switch rate was triple that of pts who were originally in MA. Further studies should assess if switching back is related to the quality of services in MA compared with MFFS.

Funding

• NIDDK Support