Dialysis facilities that perform worse according to The End-Stage Renal Disease Quality Incentive Program (ESRD QIP) and receive Medicare payment reductions have higher patient death rates than facilities without these penalties, investigators report.

“These findings strongly indicate the ESRD QIP captures meaningful and consequential markers of quality of care delivered by dialysis facilities,” according to Shannon Griffin, MPP, of Insight Policy Research in Arlington, Virginia, and colleagues.

Each year from 2010 to 2018, 5% to 42% of dialysis facilities received Medicare payment reductions from the ESRD QIP ranging up to 2%. The majority of facilities did not receive performance-based penalties, the investigators reported in the Clinical Journal of the American Society of Nephrology.

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In adjusted analyses, dialysis facilities that received 0.5%, 1.0%, 1.5%, and 2.0% Medicare payment reductions had 8%, 15%, 19%, and 34% increased risks for patient death, respectively, compared with zero payment reductions.

The investigators adjusted analyses for age, sex, race and ethnicity, dual eligibility for Medicare and Medicaid, time with end-stage kidney disease, performance year, and certain comorbidities associated with death, such as cancer and heart failure. They acknowledged that not all potential social risk factors were captured. The study covered a total of 2,793,560 patient-years. The strength of the association between mortality and ESRD QIP performance increased from 2010 to 2016 and then decreased modestly in 2017 and 2018.

Griffin’s team observed a similar mortality pattern in the years after a payment reduction. For example, facilities that received a 1.5% payment reduction due to poor performance experienced a mortality rate of 25 per 100 patient-years the following year if ESRD QIP performance did not improve, a mortality rate of 27 per 100 patient-years if the facility performed worse, and a mortality rate of 20 per 100 patient-years if the facility showed improvement.

The investigators selected facility payment reductions as an annual summary of facility quality as determined by ESRD QIP. Measures of quality are reassessed every year. Medicare payment reductions take effect 2 years after the performance year.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Griffin SM, Marr J, Kapke A, et al. Mortality risk of patients treated in dialysis facilities with payment reductions under ESRD Quality Incentive Program. Clin J Am Soc Nephrol. Published online January 20, 2023. doi:10.2215/CJN.0000000000000079