

Financial penalties not associated with improvements in quality of outpatient dialysis centers
These findings indicate a need for improvements to a Medicare program that has broad implications for the quality of outpatient dialysis in the U.S.

An observational study found that performance-based financial penalties under the Centers for Medicare & Medicaid Services (CMS) End-Stage Renal Disease Quality Incentive Program (ESRD-QIP) were not associated with improvement in the quality of outpatient dialysis centers. The penalties also did not seem to affect any of the individual outcome measures studied. The findings are published in Annals of Internal Medicine.
There are 500,000 patients on dialysis in the United States today. CMS spends about $100,000 per person/year for patients on dialysis, which is about 6-7% of the total Medicare budget and almost 1% of the total federal government budget. In 2012, the CMS started levying performance-based financial penalties against outpatient dialysis centers under the mandatory ESRD-QIP program. For many reasons, including the complexity of the program, it's effect on quality has never been measured.
Researchers from the University of Michigan studied publicly available Medicare data to determine whether penalization was associated with improvement in dialysis center quality. The data showed that 1,109 (19.0%) outpatient dialysis centers received penalties in 2017 based on performance in 2015. Penalization was not associated with improvement in total performance scores in 2017 or 2018. This was consistent across a range of different types of centers and individual quality metrics included in the program's total performance score. According to the authors, these findings are significant because they can help Medicare improve the program, which has broad implications for the quality of outpatient dialysis in the United States.
The study was conducted by Kyle Sheetz, M.D., M.Sc., chief general surgery resident at Michigan Medicine, Andrew Ryan, Ph.D., co-director of the U-M Center for Healthcare Outcomes and Policy (CHOP) and professor of health management and policy at the School of Public Health, Seth Waits, M.D., assistant professor of surgery at Michigan Medicine, and Laura Gerhardinger, M.A., a statistician at CHOP. Waits and Ryan are also members of the U-M Institute for Healthcare Policy & Innovation.
Paper cited: “Changes in Dialysis Center Quality Associated With the End-Stage Renal Disease Quality Incentive Program,” Annals of Internal Medicine. DOI: doi.org/10.7326/M20-6662
This press release was originally published by the Annals of Internal Medicine. Read the original.