Table 4.
The Association of Reimbursement Composition and CKD Quality Indicators
| Reimbursement Composition | Controlled Hypertension (BP < 130/80) in Patients with CKD and Hypertensiona % or aOR (95% CI) (N = 3028) |
p-value | Controlled Diabetes (HbA1c < 7%) in Patients with CKD and Diabetesb % or aOR (95% CI) (N = 579) |
p-value | ACEi/ARB Use in Patients with CKD and Hypertension % or aOR (95% CI) (N = 3110) |
p-value | Statin Use in Patients Age ≥ 50 with CKD % or aOR (95% CI) (N = 3381) |
p-value |
|---|---|---|---|---|---|---|---|---|
| Unadjusted Prevalence | ||||||||
| Majority Capitation | 43% | 0.040 | 78% | 0.055 | 45% | 0.994 | 21% | 0.075 |
| Majority FFS | 56% | (ref.) | 59% | (ref.) | 45% | (ref.) | 35% | (ref.) |
| Other Revenue Mix | 57% | 0.829 | 61% | 0.758 | 40% | 0.417 | 31% | 0.557 |
| Model 1 | ||||||||
| Majority Capitation | 0.61 (0.34–1.08) | 0.091 | 2.57 (0.93–7.10) | 0.068 | 1.02 (0.67–1.54) | 0.924 | 0.55 (0.21–1.42) | 0.215 |
| Majority FFS (ref.) | 1 | – | 1 | – | 1 | – | 1 | – |
| Other Revenue Mix | 1.12 (0.66–1.90) | 0.667 | 1.35 (0.67–2.74) | 0.401 | 0.88 (0.50–1.57) | 0.671 | 0.99 (0.58–1.69) | 0.957 |
| Model 2 | ||||||||
| Majority Capitation | 0.65 (0.38–1.11) | 0.113 | 2.87 (1.02–8.06) | 0.046 | 0.77 (0.45–1.32) | 0.339 | 0.75 (0.40–1.38) | 0.350 |
| Majority FFS (ref.) | 1 | – | 1 | – | 1 | – | 1 | – |
| Other Revenue Mix | 1.07 (0.62–1.87) | 0.804 | 1.49 (0.74–3.00) | 0.260 | 0.91 (0.50–1.63) | 0.744 | 0.98 (0.59–1.64) | 0.948 |
CKD chronic kidney disease, BP blood pressure, aOR adjusted odds ratio, CI confidence interval, HbA1c Hemoglobin A1c, ACEi Angiotensin converting enzyme inhibitor, ARB angiotensin receptor blocker, NSAID nonsteroidal anti-inflammatory drug
Differences in the unadjusted prevalence of quality indicators across reimbursement types were assessed using unadjusted logistic regression
Model 1 – adjusted for patient characteristics: age, sex, race, comorbidities, total number of chronic conditions, and patient payor type
Model 2 – adjusted for Model 1 + physician/practice characteristics: United States Census Region, metropolitan statistical area, solo practice, physician specialty, physician compensation, practice ownership, and physician employment status
aCKD and hypertension and nonmissing blood pressure reading
bCKD and diabetes and nonmissing HbA1c data