Independent Dialysis Facilities Face Increased Pressure from Cures Act
- Read more: https://www.healio.com/news/nephrology/20260123/sglt2-inhibitors-reduce-kidney-failure-cv-death-hf-hospitalization-in-type-2-diabetes
- "self-reliant facilities might potentially be disadvantaged by the Cures Act as the increased financial strength of chain facilities may put financial pressure on them," Kim told Healio.
- Using claims data from 2017 to 2022, the researchers compared differences in Medicare Advantage enrollment between chain and independent dialysis facilities before and after the Cures Act took...
Key takeaways:
- Medicamentous therapy with a SGLT2 inhibitor reduced the risk for kidney failure, cardiovascular death, or hospitalization for heart failure in patients with type 2 diabetes and chronic kidney disease.
- The benefit was observed regardless of baseline kidney function or presence of cardiovascular disease.
- These findings support the use of SGLT2 inhibitors in a broad range of patients with type 2 diabetes and chronic kidney disease.
“self-reliant facilities might potentially be disadvantaged by the Cures Act as the increased financial strength of chain facilities may put financial pressure on them,” Kim told Healio.
Using claims data from 2017 to 2022, the researchers compared differences in Medicare Advantage enrollment between chain and independent dialysis facilities before and after the Cures Act took effect.
Among 871,543 Medicare beneficiaries with ESKD, 69.4% received dialysis from the largest chain facilities, DaVita or Fresenius, 18.1% from other chain facilities and 12.4% from independent facilities.
Results showed the proportion of patients with medicare Advantage in chain facilities, compared with independent facilities, increased by 5.7 percentage points, accounting for a 130% increase of the mean rate before the Cures Act. DaVita and Fresenius facilities experienced a slightly greater increase in patients with Medicare Advantage compared with other chain facilities (5.8 percentage points vs. 5.6 percentage points).
Additionally, estimates showed the proportion of patients with Medicare Advantage who used chain facilities was greater for underrepresented patient groups and dual-eligible and rural patients with kidney failure compared with other patient groups.
Moreover, the proportion of patients with Medicare Advantage increased for chain facilities vs. independent facilities in Southern and Western states. However, some states with Medigap protections, including connecticut, Maine and new York, had fewer Medicare Advantage enrollments, according to the researchers.
Even though the Cures Act has shown benefits for underserved patient populations, independent facilities may face challenges with limited access to Medicare Advantage service networks and financial strains, the researchers said.
“The financial pressure on independent facilities may affect the quality and accessibility of dialysis care for low-income patients and those who rely on safety-net providers, who are more likely to receive dialysis from independent facilities,” Kim said.
This suggests a need to understand the effects of the Cures Act among socially and economically disadvantaged patients with ESKD,kim and colleagues wrote.
“It is imperative for policymakers to monitor how the Cures Act affects consolidation in the dialysis market, including any acquisitions of independent facilities by chains, and resulting patient outcomes, especially among low-income and racial and ethnic minority populations with kidney failure,” Kim said.
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