Financial penalties for dialysis centers do not increase performance

Performance-based financial penalties against outpatient dialysis centers under the End-Stage Renal Disease Quality Incentive Program (ESRD QIP) do not improve performance scores, according to a study published online May 31 in the Annals of Internal Medicine.

Kyle H. Sheetz, M.D., from the University of Michigan in Ann Arbor, and colleagues examined whether penalization is associated with improvement in dialysis center quality in a study conducted at 5,830 outpatient dialysis centers in the United States.

The researchers found that 19.0 percent of the outpatient dialysis centers received penalties in 2017 based on performance in 2015. Penalized centers were situated in ZIP codes that had a significantly higher average proportion of non-White residents (36.4 versus 31.2 percent) and residents with lower median income ($49,290 versus $51,686). There was no correlation for penalization with improvement in total performance scores in 2017 or 2018 (0.4 and 0.3 points). This was observed across centers with different characteristics. No correlation was seen between penalization and improvement in specific measures.

"Performance-based financial penalties under the ESRD QIP were not associated with improvement in the quality of outpatient dialysis centers," the authors write. "These data suggest that Centers for Medicare & Medicaid Services may consider changes to the program design as they continue to experiment with ways to improve the care of patients with ESRD."

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