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• W2195587712 abstract "Since August 2010, the DOPPS (Dialysis Outcomes and Practice Patterns Study) Practice Monitor (DPM) has provided thrice-annual updates covering many aspects of US hemodialysis care based on manual chart reviews and electronic medical record extracts from more than 200 US hemodialysis facilities. Using data presented at the DPM website (www.dopps.org/DPM), the DPM can provide “early-warning” insights regarding contemporary (within 4-6 months) trends in US hemodialysis care, with additional analysis and interpretation shortly thereafter.1Fuller D.S. Pisoni R.L. Bieber B.A. Gillespie B.W. Robinson B.M. The DOPPS Practice Monitor for US dialysis care: trends through December 2011.Am J Kidney Dis. 2013; 61: 342-346Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 2Turenne M.N. Cope E.L. Porenta S. et al.Has dialysis payment reform led to initial racial disparities in anemia and mineral metabolism management?.J Am Soc Nephrol. 2015; 26: 754-764Crossref PubMed Scopus (17) Google Scholar A special focus and expertise of the DOPPS Program has been analysis of facility-level practice patterns, an approach that we now extend to Medicare claims data. In January 2011, the Centers for Medicare & Medicaid Services (CMS) implemented a major update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)3Centers for Medicare & Medicaid ServicesMedicare Program; End-Stage Renal Disease Prospective Payment System; Final Rule and Proposed Rule.Fed Regist. 2010; 75: 49030-49214Google Scholar in which a transition in reimbursement for dialysis-related injectable medications from payment per dose to a fixed cost per patient was one of the most significant changes. Along with concerns expressed by many renal community stakeholders that patient care could be adversely affected under the new payment system,4American Society of Nephrology. ASN Comments on ESRD PPS and QIP Final Rule Nov. 2010. http://www.asn-online.org/policy/webdocs/nov2010guidanceonfinalrule.pdf. Accessed July 15, 2015.Google Scholar, 5Wish J.B. Anemia management under a bundled payment policy for dialysis: a preview for the United States from Japan.Kidney Int. 2011; 79: 265-267Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar the Government Accountability Office recommended that the CMS monitor dialysis quality metrics and access to dialysis care for beneficiaries following these payment reforms.6U.S. Government Accountability OfficeEnd-Stage Renal Disease: CMS Should Monitor Access to and Quality of Dialysis Care Promptly After Implementation of New Bundled Payment System. U.S. Government Accountability Office, Washington, DC2010Google Scholar In 2012, the CMS Claims-Based Monitoring Project,7Centers for Medicare & Medicaid Services (CMS). ESRD Payment Spotlight: ESRD Prospective Payment System (ESRD PPS) Overview of Claims-Based Monitoring Program. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/Spotlight.html. Accessed July 15, 2015.Google Scholar using data from administrative Medicare claims for reimbursement, began issuing several reports each year regarding several ESRD care indicators. These reports include patient-level estimates of hospitalizations and of the percent of ESRD beneficiaries receiving red blood cell (RBC) transfusions. In addition to the patient-level trends reported by the Claims-Based Monitoring Project, the DPM now includes distributions of facility percent of Medicare beneficiaries with at least 1 claim for inpatient hospitalization or RBC transfusion within 1- and 6-month periods. Here, we describe DPM calculation methods and present initial results for trend analyses of Medicare claims from 2010 through 2013. Under a data use agreement (DUA) with CMS, the DOPPS has received de-identified Medicare 100% inpatient (Part A) and 100% outpatient (Part B) Limited Data Sets annually since 2010. Patients receiving in-center hemodialysis are identified by a “72x” type of bill (where x is any value)8Research Data Assistance Center. Claim Facility Type Code. Outpatient LDS Data Documentation. http://www.resdac.org/cms-data/variables/Claim-Facility-Type-Code. Accessed July 15, 2015.Google Scholar, 9Research Data Assistance Center. Claim Service Classification Type Code. Outpatient LDS Data Documentation. http://www.resdac.org/cms-data/variables/Claim-Service-classification-Type-Code. Accessed July 15, 2015.Google Scholar, 10Research Data Assistance Center. Claim Frequency Code. Outpatient LDS Data Documentation. http://www.resdac.org/cms-data/variables/Claim-Frequency-Code. Accessed July 15, 2015.Google Scholar and a “0821” revenue center code for each treatment occurrence.11Research Data Assistance Center. Revenue Center Code. Outpatient LDS Data Documentation. http://www.resdac.org/cms-data/variables/revenue-center-code. Accessed July 15, 2015.Google Scholar Claim records may report up to 45 revenue center codes per segment. The “claim-through” date12Research Data Assistance Center. Claim Through Date. Outpatient LDS Data Documentation. http://www.resdac.org/cms-data/variables/Claim-Through-Date. Accessed July 15, 2015.Google Scholar is used to identify the month for reporting purposes. Inpatient hospitalization is defined as any record present in the inpatient claims file. To identify claims with an RBC transfusion, we search for a list of Healthcare Common Procedure Coding System and International Classification of Diseases, Ninth Revision (procedure) codes identified from Claims-Based Monitoring Project documentation7Centers for Medicare & Medicaid Services (CMS). ESRD Payment Spotlight: ESRD Prospective Payment System (ESRD PPS) Overview of Claims-Based Monitoring Program. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/Spotlight.html. Accessed July 15, 2015.Google Scholar; these codes are shown in Box 1.Box 1Codes Used to Identify RBC Transfusions in Medicare ClaimsHCPCS•P9010, P9011, P9016, P9021, P9022, P9038, P9039, P9040, P9051, P9054, P9056, P9057, P9058, 36430ICD-9•99.03, 99.04Abbreviations: HCPCS, Healthcare Common Procedure Coding System; ICD-9, International Classification of Diseases, Ninth Revision; RBC, red blood cell. HCPCS•P9010, P9011, P9016, P9021, P9022, P9038, P9039, P9040, P9051, P9054, P9056, P9057, P9058, 36430 ICD-9•99.03, 99.04 Abbreviations: HCPCS, Healthcare Common Procedure Coding System; ICD-9, International Classification of Diseases, Ninth Revision; RBC, red blood cell. Each month, patients are assigned to a dialysis provider facility if that facility submitted claims for at least 8 in-center hemodialysis treatments provided to the patient in that month (revenue center code 0821). To reduce the influence of discrete value effects on the variance, we limit the analyses to facilities with at least 20 assigned patients in a given month. For each outcome, the DPM provides graphs and data tables denoting the percent of beneficiaries with the given claim type each month regardless of facility assignment (patient level) and mean and percentile values for the distribution of the percent of assigned facility patients with the given event in either a 1- or 6-month period. The percent of Medicare beneficiaries with an inpatient hospitalization claim has steadily declined from 14.6% in January 2010 to 12.5% in December 2013 (Fig 1). Adjusted for monthly seasonality patterns, the year-over-year relative decline was 1.7% between 2010 and 2011, 4.1% between 2011 and 2012, and 4.2% between 2012 and 2013. In July 2013, the percent of Medicare beneficiaries with at least 1 inpatient hospitalization claim within 6 months varied nearly 2-fold across facilities, from 27.4% (10th percentile) to 50.0% (90th percentile) of facility patients; the median (50th percentile) percent was 38.6% of facility patients (Fig 2).Figure 2Distribution of facility percent of Medicare beneficiaries with at least 1 inpatient hospitalization claim within 6 months, January 2010 to July 2013. Values for each month reflect distribution among facilities with 20+ patients. The diamond marker indicates the mean value, the circle marker, the median value.Adapted with permission from Arbor Research Collaborative for Health. Data source: Medicare Claims, 2010 to 2013 (DUA#23721).View Large Image Figure ViewerDownload Hi-res image Download (PPT) The percent of Medicare beneficiaries with an RBC transfusion claim per month increased overall, from 2.7% in January 2010 to 3.1% in December 2013 (Fig 3). Beginning with the 2011 claims data set, the number of Healthcare Common Procedure Coding System code fields available on each claim record increased from 6 to 25. Estimates reported in the DPM are based on all data available on the claim record and use all 25 fields when available. The inclusion of these additional claim fields increased the estimated percent with an RBC transfusion claim by 0.2% to 0.3% consistently since January 2011 (eg, 3.2% using all 25 fields vs 3.0% using the first 6 fields in January 2011). Adjusted for monthly seasonality patterns, the year-over-year relative increase was 21.4% between 2010 and 2011 and 7.2% between 2011 and 2012, with a 4.9% year-over-year relative decline between 2012 and 2013. In July 2013, the percent of Medicare beneficiaries with at least 1 RBC transfusion claim within 6 months varied 5-fold across facilities, from 3.6% (10th percentile) to 18.4% (90th percentile) of facility patients; the median (50th percentile) percent was 10.0% of facility patients (Fig 4).Figure 4Distribution of facility percent of Medicare beneficiaries with at least 1 red blood cell transfusion claim within 6 months, January 2010 to July 2013. Values for each month reflect distribution among facilities with 20+ patients. The diamond marker indicates the mean value, the circle marker, the median value. The maximum number of procedures per inpatient claim in the claims data set increased from 6 to 25 starting in January 2011.Adapted with permission from Arbor Research Collaborative for Health. Data source: Medicare Claims, 2010 to 2013 (DUA#23721).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Using contemporary CMS claims data, the DPM identified a continual decline in hospitalization from 2010 to 2013 among Medicare beneficiaries treated with hemodialysis. In contrast, the percent of beneficiaries with an RBC transfusion claim during a month increased starting in 2011, perhaps due to the combined effects of the initial rollout of the revised PPS in January 20113Centers for Medicare & Medicaid ServicesMedicare Program; End-Stage Renal Disease Prospective Payment System; Final Rule and Proposed Rule.Fed Regist. 2010; 75: 49030-49214Google Scholar and the greater decline in hemoglobin levels following modifications to erythropoiesis-stimulating agent drug labeling and the ESRD Quality Incentive Program in June/July 2011.13US Food and Drug Administration, US Department of Health and Human Services. FDA Drug Safety Communication: modified dosing recommendations to improve the safe use of erythropoiesis-stimulating agents (ESAs) in chronic kidney disease. Safety Announcement June 24, 2011. http://www.fda.gov/drugs/drugsafety/ucm259639.htm. Accessed July 15, 2015.Google Scholar, 14Centers for Medicare & Medicaid Services (CMS), HHSMedicare Program; End-Stage Renal Disease Prospective Payment System and Quality Incentive Program; Ambulance Fee Schedule; Durable Medical Equipment; and Competitive Acquisition of Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies; Proposed Rule.Fed Regist. 2011; 76: 40498-40550Google Scholar However, the subsequent decline in the percent of beneficiaries with an RBC transfusion claim in a month, most notable in 2013, suggests a return toward 2010 levels. For both hospitalization and RBC transfusion claims, we observed wide variation among facilities, which could be driven by both patient case-mix and facility practice pattern factors. It is important to note that these results are not adjusted for patient case-mix and thus should not be used for formal benchmarking or in comparison to adjusted metrics such as the standardized hospitalization ratio or standardized transfusion ratio. The distribution of facility percent of patients with at least 1 inpatient hospitalization claim within 6 months is normally distributed, suggesting that there are no particular excesses of either strongly or poorly performing facilities. The observed net decline at all reported percentiles suggests that efforts to reduce hospitalizations are occurring on a very broad scale across US hemodialysis facilities. By contrast, the distribution of facility percent of patients with at least 1 RBC transfusion claim within 6 months appears to have a slight positive skew, suggesting the variation may be influenced by an excess of facilities with a higher percentage with an RBC transfusion claim. This may arise by clustering of high-risk patients in certain facilities or by similar skews in the facility percentage of patients treated to lower hemoglobin levels across facilities and/or the threshold of physician providers within a facility or within a hospital to which a facility refers patients for transfusion procedures. In summary, the DPM provides a uniquely rich source of data capable of identifying early warning insights regarding contemporary trends in US hemodialysis care. To that end, the DPM now incorporates Medicare claims data, providing facility-level distributions for the percent of Medicare ESRD beneficiaries hospitalized or with a claim for RBC transfusion during 1- and 6-month periods. As with the other DPM measures, stratified reporting of these estimates by patient-level (eg, transplantation eligible) or facility-level (eg, facility setting or location) subgroups is anticipated. Future work also may attempt to explain observed facility variation by incorporating patient case-mix adjustment for the covariates available in Medicare claims records (eg, age group, sex, race, and geography) and through facility-level linkage to more detailed contemporary DOPPS data. Support: The DOPPS Program is supported by Amgen, Kyowa Hakko Kirin, AbbVie Inc, Sanofi Renal, Baxter Healthcare, and Vifor Fresenius Medical Care Renal Pharma, Ltd. Additional support for specific projects and countries is also provided by Amgen, BHC Medical, Janssen, Takeda, and Kidney Foundation of Canada (for logistics support) in Canada; Hexal, Deutsche Gesellschaft fur Nephrologie (DGfN), Shire, and WiNe Institute in Germany; and the Japanese Society for Peritoneal Dialysis for Peritoneal Dialysis Outcomes and Practice Patterns Study in Japan. All support is provided without restrictions on publications. Financial Disclosure: Dr Pisoni has received speaker fees from Amgen, Kyowa Hakko Kirin, and Vifor and served on an advisory panel for Merck. Dr Robinson has received speaker fees for Kyowa Hakko Kirin. The other authors declare that they have no relevant financial interests." @default.
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• W2195587712 title "Hemodialysis Facility Variation in Hospitalization and Transfusions Using Medicare Claims: The DOPPS Practice Monitor for US Dialysis Care" @default.
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