Session Name: Non-Organ Specific: Public Policy & Allocation
Session Date & Time: None. Available on demand.
*Purpose: The Centers for Medicare & Medicaid Services (CMS) introduced the Quality Incentive Program (QIP) in 2012, a pay-for-performance program which penalizes dialysis centers payments up to 2% based on performance on publicly reported quality measures of clinical outcomes, safety reporting, and care coordination. It is unknown if these ratings translate to improved access to transplantation, defined as listing within 1 year of dialysis start.
*Methods: Using the incident cohort of patients beginning dialysis in 2013 from the United States Renal Data System, patients were followed for one year to assess 1-year transplant listing rates. Dialysis facility QIP scores were obtained from Medicare Dialysis Facility Compare. We analyzed unadjusted 1-year listing rates by levels of QIP score. Using a multivariable logistic regression model that controlled for patient and facility-level factors, we then assessed the relationship between quality as measured by QIP performance and 1-year listing rates. QIP scores < 40 lead to a payment reduction of at least 1.5%.
*Results: There was a significantly higher unadjusted rate of listing for transplantation at higher performing centers (8.1 vs 4.5%, ≥75 vs <40, P<0.001). In analyses adjusted for patient- and facility-level covariates, the odds of listing were higher at QIP score ≥75 vs <40 facilities (OR 1.90, P<0.001). Patients from urban (OR 1.23, P<0.001), non-profit (OR 1.37, P<0.001), and small (OR 1.25, P<0.001) dialysis facilities were more likely to be listed within 1 year.
*Conclusions: There was a significant association between better dialysis facility quality, as measured by the QIP score, and higher likelihood of listing for transplantation. Given the national policy goal of increasing listing transplantation, 1 year listing rates could be considered as part of the QIP metric to incentivize dialysis center referral to transplant centers.
To cite this abstract in AMA style:Adler JT, Xiang L, Weissman JS, Rodrigue JR, Patzer RE, Waikar SS, Tsai TC. The Quality Incentive Program (QIP) is Associated with Increased Waitlisting for Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-quality-incentive-program-qip-is-associated-with-increased-waitlisting-for-transplantation/. Accessed June 20, 2021.
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