The Centers for Medicare and Medicaid Services is penalizing some dialysis facilities that disproportionately serve patients who are low-income or people of color for failing to provide in-home treatment.
An observational study of nearly 2,200 dialysis facilities participating in the agency’s End Stage Renal Disease Treatment Choices model found safety-net facilities serving mostly Black and Hispanic patients more frequently experienced CMS reimbursement cuts as high as 5% in the first year of the payment model for not moving more treatment to the home. The results of the study by researchers at five universities were published Tuesday in JAMA Network.
Related: Black and Hispanic patients face roadblocks to home dialysis
CMS launched the payment model in 2021 to incentivize dialysis providers to move treatment to the home or encourage transplants in an effort to reduce healthcare spending. CMS randomly selected approximately 3,500 dialysis facilities to participate in the pilot program. Participants receive bonuses or reimbursement cuts based on performance.
Researchers assigned scores to dialysis centers based on a number of social risk features: the proportion of patients who were Black or Hispanic, lived in highly disadvantaged neighborhoods, were uninsured or were covered by Medicaid. They found nearly half the facilities had no risk features, while approximately a quarter had two or more.
The study found facilities with higher risk scores tended to have lower home dialysis use, which more frequently resulted in payment cuts. Those facilities with the highest risk scores saw the highest reimbursement cut of 5% and were also less likely to receive the highest bonus payment of 4%.
The study comes just days after CMS released a report that found the End Stage Renal Disease Treatment Choices model is not producing the results the agency intended. The report prepared for CMS by business consulting firm the Lewin Group found no evidence the payment model has had any effect on the use of home dialysis or transplants during the first two calendar years of the model. The pilot program runs through 2027.
CMS is trying to drive more dialysis into the home to reduce the overall cost of treating end-stage renal failure. In 2019 the diease cost Medicare approximately $37 billion, or 7% of total spending, according to the most recent estimates by the Centers for Disease Control and Prevention.
Uptake of home dialysis has been slow among some patient groups. In 2021, approximately 11% of Black patients and 12% of Hispanic patients with renal failure used or received home dialysis compared with nearly 15% of white patients, according to the latest statistics by the United States Renal Data System.
A separate study published last year in JAMA Network found some Latino home dialysis patients in Houston and Denver had difficulty arranging home treatment in part because physicians did not properly communicate treatment options to them.
