• Kyle H Sheetz, Laura Gerhardinger, Andrew M Ryan, and Seth A Waits.
• University of Michigan, Center for Healthcare Outcomes and Policy, and Center for Evaluating Health Reform, Ann Arbor, Michigan (K.H.S.).
• Ann. Intern. Med. 2021 Aug 1; 174 (8): 1058-1064.

BackgroundIn 2012, the Centers for Medicare & Medicaid Services started levying performance-based financial penalties against outpatient dialysis centers under the mandatory End-Stage Renal Disease Quality Incentive Program.ObjectiveTo determine whether penalization was associated with improvement in dialysis center quality.DesignLeveraging the threshold for penalization (total performance score < 60), a regression discontinuity design was used to examine the effect of penalization on quality over 2 years. Publicly available Medicare data from 2015-2018 were used. The effect of penalization at dialysis centers with different characteristics (for example, size or chain affiliation) was also examined.SettingUnited States.ParticipantsOutpatient dialysis centers (n = 5830).MeasurementsDialysis center total performance scores (a composite metric ranging from 0 to 100 based on clinical quality and adherence to reporting requirements) and individual measures that contribute to the total performance score.ResultsThere were 1109 (19.0%) outpatient dialysis centers that received penalties in 2017 on the basis of performance in 2015. Penalized centers were located in ZIP codes with a higher average proportion of non-White residents (36.4% vs. 31.2%; P < 0.001) and residents with lower median income ($49 290 vs. $51 686; P < 0.001). Penalization was not associated with improvement in total performance scores in 2017 (0.4 point [95% CI, -2.5 to 3.2 points]) or 2018 (0.3 point [CI, -2.8 to 3.4 points]). This was consistent across dialysis centers with different characteristics. There was also no association between penalization and improvement in specific measures.LimitationThe study could not account for how centers respond to penalization.ConclusionPenalization under the End-Stage Renal Disease Quality Incentive Program was not associated with improvement in the quality of outpatient dialysis centers.Primary Funding SourceNone.

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