Abstract: FR-PO434
Commercial Health Insurance and Quality of Care in US Dialysis Facilities
Session Information
- Hemodialysis Epidemiology and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Erickson, Kevin F., Baylor College of Medicine, Houston, Texas, United States
- Bhatnagar, Anshul, Baylor College of Medicine, Houston, Texas, United States
- Weiner, Daniel E., Tufts University School of Medicine, Boston, Massachusetts, United States
- Reaves, Allison Cook, Tufts Medical Center, Boston, Massachusetts, United States
Background
Commercial health insurance typically reimburses at a higher rate for dialysis than Medicare. A recent ruling by the US Supreme Court could result in many commercially insured patients who receive dialysis forgoing their commercial health insurance and shifting to Medicare as the primary payer. We examined whether differences in commercial payers as a proportion of a facility’s overall payer mix is associated with the quality of care at dialysis facilities.
Methods
We used publicly available data from US Dialysis Facility Reports and the Dialysis Facility Compare websites in 2019 to identify patients receiving dialysis in the United States. In multivariable linear regression models, we examined the association between the percentage of incident dialysis patients with commercial insurance and seven key dialysis facility quality metrics included in dialysis facility STAR ratings.
Results
Among 5,753 US dialysis facilities, on average 12.0% of incident dialysis patients had commercial insurance. Each 10% absolute increase in percentage of dialysis patients in a facility with commercial insurance was associated with an adjusted 6.7% (95% Confidence Interval (CI) 5.5-7.9%) lower standardized mortality ratio, 2.7% (1.9-3.4%) lower standardized hospitalization ratio, and absolute decreases of 4.0% (2.0-6.0%) in the standardized transfusion ratio, 0.2% (0.1-0.2%) in patient months without adequate dialysis, and 0.7% (0.5-1.0%) in months with a long-term catheter. Higher commercial insurance rates were associated with an increase of 0.8% (0.5-1.1%) in the standardized arteriovenous fistula rate and a 0.05 (0.01-0.10) point higher Consumer Assessment of Healthcare Providers and Systems patient experience score.
Conclusion
These findings suggest that shifting coverage from commercial health insurance to Medicare could adversely impact quality of care at dialysis facilities.