Medicare Advantage Enrollment Increased Disproportionately In Chain-Owned Dialysis Facilities After The Cures Act

Area of Science:

• Health policy
• Nephrology
• Health economics

Background:

• The 21st Century Cures Act (January 2021) permitted Medicare beneficiaries with end-stage renal disease (ESRD) to enroll in Medicare Advantage (MA) plans.
• The dialysis industry is highly concentrated, with two major chains dominating 75% of Medicare dialysis treatments.
• Industry concentration enables large chains to negotiate higher reimbursements from MA plans compared to traditional Medicare.

Purpose of the Study:

• To evaluate the impact of the 21st Century Cures Act on Medicare Advantage enrollment among patients with end-stage renal disease.
• To assess differential effects of the Act on chain-owned versus independent dialysis facilities.
• To examine disparities in Medicare Advantage enrollment based on patient demographics and location.

Main Methods:

• Utilized a difference-in-differences approach.
• Analyzed Medicare enrollment and claims data from 2017-2022.
• Compared MA enrollment rates in chain-owned facilities versus independent facilities before and after the Cures Act implementation.

Main Results:

• Medicare Advantage enrollment increased by 5.7 percentage points more in chain facilities compared to independent facilities post-Cures Act, a 130% increase relative to the pre-Act mean in chain facilities.
• Differential MA enrollment growth was more pronounced in chain facilities serving racial and ethnic minority, dual-eligible, and rural patients.
• Findings indicate a significant increase in MA enrollment favoring chain dialysis providers.

Conclusions:

• The 21st Century Cures Act has potentially enhanced the financial standing of chain dialysis facilities.
• Disproportionate increases in MA enrollment were observed among vulnerable populations (low-income, minority, rural) treated in chain facilities.
• Policy changes may exacerbate existing disparities in healthcare access and financial burden for ESRD patients.