Dialysis & Racial Disparities: Facility Quality Matters
- Manny patients wiht end-stage kidney disease (ESKD) begin dialysis at facilities affiliated with their nephrologists, even if those facilities have lower quality ratings, according to a recent study...
- The study examined over 140,000 Medicare beneficiaries starting dialysis at freestanding U.S.facilities.
- Interestingly, the study found that patients were less likely to start dialysis at their nephrologistS primary facility as the facility's quality rating increased. Proximity,however,played a significant role. Patients...
the chief takeaway: Patients seeking dialysis frequently prioritize proximity over quality, contributing to racial disparities in care.A recent study reveals that individuals often choose facilities near their nephrologists, even if those centers have lower ratings that could impact their health. The research, which examined Medicare data, highlights that this trend disproportionately affects Black patients, who are less likely to receive care at high-quality facilities. The primary_keyword,dialysis facility quality,and the secondary_keyword,racial disparities,are intertwined,suggesting that policy changes are crucial to ensure equitable access. News Directory 3 can provide you with ongoing coverage about such critical access issues. Policymakers may need to refine the dialysis Facility Compare resource. Discover what’s next for patients and healthcare solutions.
Dialysis Facility Choice Driven by Proximity, Not Quality, Study Finds
updated May 31, 2025
Manny patients wiht end-stage kidney disease (ESKD) begin dialysis at facilities affiliated with their nephrologists, even if those facilities have lower quality ratings, according to a recent study in JAMA Health Forum. The research, analyzing Medicare data from 2015 to 2020, highlights concerns about dialysis quality and racial disparities in care access. Initiating dialysis is a critical period, with patients facing a 20% one-year mortality rate.
The study examined over 140,000 Medicare beneficiaries starting dialysis at freestanding U.S.facilities. Researchers assessed facility quality using the Centers for Medicare & Medicaid Services (CMS) 5-star rating system and analyzed its impact on patient outcomes. the findings suggest that continuity of care,specifically staying with a familiar nephrologist,frequently enough outweighs the quality of the dialysis facility itself.
Interestingly, the study found that patients were less likely to start dialysis at their nephrologistS primary facility as the facility’s quality rating increased. Proximity,however,played a significant role. Patients were more inclined to choose a facility geographically close to their nephrologist, regardless of its quality score. Each additional star in a facility’s rating correlated with fewer hospitalizations, indicating better patient outcomes at higher-quality centers.
Racial disparities in dialysis quality access were also evident. Black patients were less likely than White patients to receive treatment from nephrologists associated with high-quality facilities. They were also less likely to start dialysis at high-quality centers, even after adjusting for geographic and demographic factors. This disparity persisted within the same hospital service areas.
Researchers noted that when a nephrologist’s primary dialysis facility was nearby, patients were significantly more likely to choose it, irrespective of its quality rating. This suggests that convenience and established relationships may be prioritized over objective measures of care quality when making decisions about dialysis care.
“In this cohort study of FFS Medicare patients who initiated dialysis for ESKD [end-stage kidney disease] primary facility starts were common, especially if primary facilities were close to patients and even when they were low quality,” the researchers wrote.
The study authors suggest that these findings have critically important policy implications. As primary facility starts may exacerbate existing racial disparities in dialysis quality, interventions are needed to improve access to high-quality care.This could include strategies such as subsidies or incentives to encourage the relocation of high-quality dialysis facilities to underserved areas.
What’s next
Policymakers may need to enhance the effectiveness of the dialysis Facility Compare (DFC) tool,including improving its publicity to patients,to ensure that individuals are making informed decisions about their dialysis care based on quality rather than convenience.