title: Predictors of provider-patient visit frequency during hemodialysis.
abstract: OBJECTIVE
  In 2004, the Centers for Medicare and Medicaid Services tied reimbursement for outpatient hemodialysis services to the number of times per month providers see their dialysis patients, resulting in increased provider-patient visit frequency. Greater provider-patient visit frequency is associated with lower hospitalization risk for hemodialysis patients, and determinants of visit frequency are uncertain. We aimed to identify patient, provider, and dialysis facility characteristics associated with provider visit frequency.
  
  
  METHODS
  This retrospective cohort study used United States Renal Data System (USRDS) data for point-prevalent patients receiving in-center hemodialysis on January 1, 2006 (n = 144,860). Patient characteristics were defined from January 1 to June 30, 2006, and provider-patient visit frequency (<4 vs. ≥4 visits/month) from July 1 to December 31, 2006. Patient characteristics were obtained from the USRDS. Provider data were obtained from the American Medical Association Physician Master File. We determined longitudinal associations between patient, provider, and facility characteristics and provider-patient visit frequency using logistic regression.
  
  
  RESULTS
  Patient characteristics independently associated with greater provider-patient visit frequency included older age, African-American race, longer dialysis duration, higher comorbidity score, Medicaid eligibility, urban residence, better compliance with dialysis, and more hospital days during run-in. Provider characteristics associated with greater provider-patient visit frequency included more years in practice, graduation from a foreign medical school, shorter distance between provider office and dialysis unit, and caring for more dialysis patients; facility characteristics included free-standing, independent status.
  
  
  CONCLUSIONS
  After the Medicare reimbursement policy change, several patient, provider, and facility characteristics were independently associated with greater dialysis provider-patient visit frequency.
authors.affiliation: Veterans Administration Health Care System, University of Minnesota, Minneapolis, Minn. 55417, USA. slini001@umn.edu
authors.forename: Yelena
authors.initials: Y
authors.lastname: Slinin
authors.forename: Haifeng
authors.initials: H
authors.lastname: Guo
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Jiannong
authors.initials: J
authors.lastname: Liu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Morgan
authors.forename: Kristine
authors.initials: K
authors.lastname: Ensrud
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D000554:Ambulatory Care Facilities; D014487:Centers for Medicare and Medicaid Services, U.S.; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011369:Professional-Patient Relations; D006435:Renal Dialysis / Q000379:methods* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult