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Published on: October 2, 2020
Predictors of provider-patient visit frequency during hemodialysis
Yelena Slinin1, Haifeng Guo, Suying Li
1Veterans Administration Health Care System, University of Minnesota, Minneapolis, Minn. 55417, USA. slini001@umn.edu
Insights
Patient, provider, and dialysis facility factors influence hemodialysis visit frequency. Understanding these determinants can help optimize care and potentially reduce hospitalization risks for patients undergoing hemodialysis.
Area of Science:
- Nephrology
- Health Services Research
- Health Economics
Background:
- Centers for Medicare and Medicaid Services (CMS) reimbursement policy changes in 2004 incentivized increased provider-patient visit frequency for outpatient hemodialysis.
- Higher visit frequency is linked to reduced hospitalization risk in hemodialysis patients.
- The factors influencing this increased visit frequency remain unclear.
Purpose of the Study:
- To identify patient, provider, and dialysis facility characteristics associated with increased provider-patient visit frequency in hemodialysis care.
- To understand the determinants of visit frequency following the CMS reimbursement policy shift.
Main Methods:
- Retrospective cohort study utilizing United States Renal Data System (USRDS) data.
- Analysis of 144,860 prevalent, in-center hemodialysis patients.
- Logistic regression used to determine associations between patient, provider, and facility characteristics and visit frequency (<4 vs. ≥4 visits/month).
Main Results:
- Patient factors linked to higher visit frequency: older age, African-American race, longer dialysis duration, higher comorbidity, Medicaid eligibility, urban residence, better compliance, and more hospital days.
- Provider factors: more years in practice, foreign medical school, shorter office-dialysis distance, and higher patient volume.
- Facility factors: free-standing, independent status.
Conclusions:
- Several patient, provider, and facility characteristics are independently associated with increased dialysis provider-patient visit frequency.
- These findings offer insights into care patterns following the Medicare reimbursement policy change.
Background/Aims:
In 2004, the Centers for Medicare and Medicaid Services tied reimbursement for outpatient hemodialysis services to the number of times per month providers see their dialysis patients, resulting in increased provider-patient visit frequency. Greater provider-patient visit frequency is associated with lower hospitalization risk for hemodialysis patients, and determinants of visit frequency are uncertain. We aimed to identify patient, provider, and dialysis facility characteristics associated with provider visit frequency.
Methods:
This retrospective cohort study used United States Renal Data System (USRDS) data for point-prevalent patients receiving in-center hemodialysis on January 1, 2006 (n = 144,860). Patient characteristics were defined from January 1 to June 30, 2006, and provider-patient visit frequency (<4 vs. ≥4 visits/month) from July 1 to December 31, 2006. Patient characteristics were obtained from the USRDS. Provider data were obtained from the American Medical Association Physician Master File. We determined longitudinal associations between patient, provider, and facility characteristics and provider-patient visit frequency using logistic regression.
Results:
Patient characteristics independently associated with greater provider-patient visit frequency included older age, African-American race, longer dialysis duration, higher comorbidity score, Medicaid eligibility, urban residence, better compliance with dialysis, and more hospital days during run-in. Provider characteristics associated with greater provider-patient visit frequency included more years in practice, graduation from a foreign medical school, shorter distance between provider office and dialysis unit, and caring for more dialysis patients; facility characteristics included free-standing, independent status.
Conclusion:
After the Medicare reimbursement policy change, several patient, provider, and facility characteristics were independently associated with greater dialysis provider-patient visit frequency.
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