Shawn M. Carter , 2025-05-02 14:23:00
Key takeaways:
- The average percentage of patients with commercial insurance at U.S. dialysis centers was 4.4%.
- Each 10% increase in patients with commercial insurance was linked to an 8.3% lower standardized mortality ratio.
Dialysis facilities with more patients on commercial vs. private health insurance performed better in standardized mortality ratio, according to data from the Baylor College of Medicine.
Researchers in a cross-sectional study found that shifting coverage from commercial to private Medicare plans could negatively impact quality of care at U.S. facilities. Commercial plans often reimburse at a higher rate for dialysis than Medicare, Kevin Erickson, MD, MS, associate professor of medicine in nephrology at Baylor College of Medicine, told Healio.
The average percentage of patients with commercial insurance was 4.4%. Image: Adobe Stock.
However, the U.S. Supreme Court ruling on Marietta Memorial Hospital Employee Health Benefit Plan v. DaVita Inc. could result in many patients receiving dialysis switching from commercial insurance plans to Medicare as the primary payer, according to the study.
“If this finding reflects a causal connection, then the shifting of patients from commercial insurance to Medicare, as might happen in the wake of [the court ruling], could be detrimental to patient outcomes,” Erickson said.
The researchers set out to pinpoint whether differences in commercial payer mix are associated with quality of care at 7,194 US dialysis facilities. Investigators evaluated metrics from the Dialysis Facility Compare star ratings in 2019. The main outcome focused on seven key dialysis facility quality measures, including hospitalization ratios and patient experience scores.
Of all the dialysis facilities analyzed in the study, the average percentage of patients with commercial insurance was 4.4%, according to the findings. Each 10% increase in this percentage was associated with an 8.3% decrease in standardized mortality ratios.
While having more patients with commercial insurance was tied to improved mortality rates, it was not correlated with other quality measures, such as fistula rate, long-term catheter rate, standardized hospitalization ratio, standardized transfusion ratio and dialysis adequacy.
“It may be important to find ways to preserve the quality of care at dialysis facilities that have fewer commercially insured patients,” Erickson said. “This could come in the form of more stringent quality monitoring and enforcement along with additional resources to make up for lower revenues from noncommercial payors.”
Further “research will also need to address potential confounders, such as unobserved socioeconomic status, which could have biased our results,” he said.
For more information:
Kevin Erickson, MD, MS, can be reached at kevin.erickson@bcm.edu.
Sources/Disclosures
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Disclosures:
Erickson reports receiving consultant fees from Acumen, Boehringer Ingelheim, Fresenius Medical, Outset Medical and honoraria from DCI and Columbia University; and serves on an advisory committee at Fresenius Medical Care. Please see the study for all other authors’ relevant financial disclosures.
