Agreement of reported vascular access on the medical evidence report and on medicare claims at hemodialysis initiation

Abstract

BackgroundThe choice of vascular access type is an important aspect of care for incident hemodialysis patients. However, data from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (form CMS-2728) identifying the first access for incident patients have not previously been validated. Medicare began requiring that vascular access type be reported on claims in July 2010. We aimed to determine the agreement between the reported vascular access at initiation from form CMS-2728 and from Medicare claims.MethodsThis retrospective study used a cohort of 9777 patients who initiated dialysis in the latter half of 2010 and were eligible for Medicare at the start of renal replacement therapy to compare the vascular access type reported on form CMS-2728 with the type reported on Medicare outpatient dialysis claims for the same patients. For each patient, the reported access from each data source was compiled; the percent agreement represented the percent of patients for whom the access was the same. Multivariate logistic analysis was performed to identify characteristics associated with the agreement of reported access.ResultsThe two data sources agreed for 94% of patients, with a Kappa statistic of 0.83, indicating an excellent level of agreement. Further, we found no evidence to suggest that agreement was associated with the patient characteristics of age, sex, race, or primary cause of renal failure.ConclusionThese results suggest that vascular access data as reported on form CMS-2728 are valid and reliable for use in research studies.

Impact of Poverty and Health Care Insurance on Arteriovenous Fistula Use among Incident Hemodialysis Patients

“…Recently, Solid et al [17] compared vascular access data reported on CMS Form 2728 with Medicare outpatient claims for the same patients upon HD initiation and demonstrated excellent agreement between the 2 data sources (agreement for 94% of patients, with a Kappa statistic of 0.83). This study was approved as exempted from review by the Walter Reed National Military Medical Center Institutional Review Board.…”

A comparison between physicians and computer algorithms for form CMS‐2728 data reporting

“…The law requires that the comorbidity section of the form needs to be completed by the nephrologist whereas other sections can be completed by support staff in the dialysis facility. Significant time, effort and extensive access to the medical record may be needed for physicians to accurately complete the 2728 form, and previous studies have confirmed that the current system of manual completion is often erroneous . Data from the previous 10 years can be used for completion, but evaluating such voluminous data from multiple Electronic Medical Records (EMR) systems is time consuming.…”

Outcomes of Elderly Patients after Predialysis Vascular Access Creation

“…In a recent study, vascular access data as reported by CMS Form 2728 was determined to be valid and reliable for use in research studies. 31 Evaluation by a nephrologist before dialysis initiation was determined by using physician supplier claims in the 2 years preceding dialysis. Patients who initiated dialysis before 2004 and 2005 were excluded because information on vascular access was not fully collected before 2005.…”