Bundled Payment Reform and Dialysis Facility Closures in ESKD

Area of Science:

• Health Services Research
• Health Economics
• Nephrology Policy

Background:

• In 2011, the End-Stage Kidney Disease (ESKD) payment bundle was expanded to include injectable medications.
• This policy change raised concerns about potential dialysis facility closures due to increased costs, which could disrupt patient care and access.
• The impact of this payment reform on dialysis facility closure rates remained unexamined.

Purpose of the Study:

• To determine if dialysis facility closures increased following the 2011 ESKD payment bundle expansion.
• To investigate whether the factors influencing facility closures changed post-policy reform.
• To analyze the association between patient and facility characteristics and closure risk before and after the payment reform.

Main Methods:

• Analysis of US Renal Data System registry data for in-center hemodialysis patients from 2006-2015.
• Utilized interrupted time series logistic regression models to assess changes in closure likelihood.
• Examined the influence of patient, facility, and geographic characteristics on closure risk.

Main Results:

• Dialysis facility closures were infrequent during the study period.
• Adjusted models showed a 37% decrease in the odds of closure immediately after the payment reform (OR, 0.63).
• An additional 6% annual decline in closure odds was observed post-reform, with minor increases in closures for Black patients at small, hospital-based facilities and decreases for Hispanic and dual-eligible patients.

Conclusions:

• The expansion of the ESKD payment bundle was not associated with an overall increase in dialysis facility closures.
• The policy reform led to a decrease in closure likelihood, though some high-risk populations experienced slight changes.
• Findings suggest the payment reform did not negatively impact overall dialysis facility stability.