Acute Care Facility Utilization Among Renal Transplant and Dialysis Patients in a Medicare Accountable Care Organization.

Abstract

Background: Accountable Care Organizations (ACO) in the U.S. are relatively new. Although dialysis patients or renal transplant recipients have traditionally had narrowly focused clinical measures, ACOs and more broad quality care measures are just being considered for ESRD patients. In one of our Medicare Shared Savings Program (MSSP) ACOs, renal transplant and dialysis patients are included in the lives attributed to our providers. Uniquely, we are able to inform on utilization measures that have to date not been well understood among ESRD patients who in our MSSP ACO are a contemporaneous subset of a larger population with non-ESRD patients. Methods: MSSP ACO populations are traditional Medicare patients who have had their primary care services delivered predominantly by any of the providers in our ACO. Data provided by Medicare are from active patients in the ACO from Jan 2012-July 2013. Rates of Emergency Department visits, Admissions, and Readmissions are described. Multivarable analyses are planned. Results: Non-ESRD (N=8,170), chronic dialysis (N=178), and renal transplant (n=372) patients comprise the ACO population. Septicemia, complications of dialysis access, and complications of renal transplant were the most common admitting diagnoses, and readmissions were most commonly due to septicemia, septicemia, and complications of renal transplant, respectively for non-ESRD, dialysis and renal transplant patients. Dialysis patients had a 3-fold higher use of EDs, and had more than a 4-fold higher rate of admissions than non-ESRD patients. Renal transplant recipients were more similar to non-ESRD group for ED utilization, but had a 2-fold higher rate of admissions than non-ESRD group. Rates of readmission were comparable across groups. Conclusions: Dialysis patients within a Medicare ACO have considerable utilization of acute care facilities, yet renal transplant recipients had lower rates of admission than dialysis patients. Readmissions are not a significant concern within this Medicare ACO. Alternative strategies are required in these areas to deliver more cost-efficient and quality care for dialysis patients.Table: No Caption available.