TY - JOUR
T1 - The role of social risk factors in dialysis facility ratings and penalties under a medicare quality incentive program
AU - Qi, Andrew C.
AU - Butler, Anne M.
AU - Joynt Maddox, Karen E.
N1 - Funding Information:
Karen Joynt Maddox previously did contract work for the Department of Health and Human Services.
Publisher Copyright:
© 2019 Project HOPE-The People-to-People Health Foundation, Inc.
PY - 2019/7
Y1 - 2019/7
N2 - Medicare’s End-Stage Renal Disease Quality Incentive Program is a mandatory pay-for-performance program for US dialysis facilities, in which facilities are penalized up to 2 percent of their total Medicare payments based on their performance on quality metrics. While analyses of similar programs in other settings have shown performance to be related to social risk factors, it is unknown whether this program displays similar patterns. In this national study, facilities located in lowincome ZIP codes and with high proportions of patients who were black or dually enrolled in Medicaid had lower performance scores and higher rates of penalization under the program. Independent (versus chain) status, large facility size, and urban location were also associated with penalties. Further study is needed to determine the degree to which these patterns reflect low-quality care delivery versus patient factors beyond providers’ control. In the meantime, the impact of these penalties on providers serving vulnerable populations should be tracked closely.
AB - Medicare’s End-Stage Renal Disease Quality Incentive Program is a mandatory pay-for-performance program for US dialysis facilities, in which facilities are penalized up to 2 percent of their total Medicare payments based on their performance on quality metrics. While analyses of similar programs in other settings have shown performance to be related to social risk factors, it is unknown whether this program displays similar patterns. In this national study, facilities located in lowincome ZIP codes and with high proportions of patients who were black or dually enrolled in Medicaid had lower performance scores and higher rates of penalization under the program. Independent (versus chain) status, large facility size, and urban location were also associated with penalties. Further study is needed to determine the degree to which these patterns reflect low-quality care delivery versus patient factors beyond providers’ control. In the meantime, the impact of these penalties on providers serving vulnerable populations should be tracked closely.
UR - http://www.scopus.com/inward/record.url?scp=85069261155&partnerID=8YFLogxK
U2 - 10.1377/hlthaff.2018.05406
DO - 10.1377/hlthaff.2018.05406
M3 - Article
C2 - 31260369
AN - SCOPUS:85069261155
SN - 0278-2715
VL - 38
SP - 1101
EP - 1109
JO - Health Affairs
JF - Health Affairs
IS - 7
ER -