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The following is a summary of “A retrospective multi-site examination of chronic kidney disease using longitudinal laboratory results and metadata to identify clinical and financial risk,” published in the December 2024 issue of Nephrology by Fung et al.
Researchers conducted a retrospective study at 3 health care organizations to assess clinical gaps in care for stage 3 or 4 chronic kidney disease (CKD) and identify financial opportunities in US risk adjustment systems. They also evaluated the lack of CKD assessment in patients with diabetes.
They evaluated outpatient laboratory results and metadata from electronic medical records, laboratory systems, and billing data for 2021. Laboratory results were compared with ICD-10 codes and Hierarchical Condition Categories (HCC) to assess if CKD was documented. Adults aged 18–75 were included, while inpatient results and pregnant individuals were excluded.
The results showed that at the 3 institutions, 12,478 of 16,063 patients (78%), 487 of 1,511 patients (32%), and 19,433 of 29,277 patients (66%) with stage 3 or 4 CKD had no ICD-10 or HCC codes. Among patients with diabetes (HbA1c ≥ 6.5%), 34,384 of 58,278 patients (59%), 2,274 of 2,740 patients (83%), and 40,378 of 52,440 patients (77%) did not undergo guideline-recommended CKD testing. An estimated 3,246 of 32,398 patients (9.9%) with undocumented CKD stages 3–4 was enrolled in Medicare Advantage or Affordable Care Act (ACA) programs, leading to $2.85 million in imputed reimbursement losses across the 3 institutions.
Investigators demonstrated that clinical laboratories added value beyond diagnostics by identifying care gaps in CKD management, stratifying patient risk, and addressing missed reimbursement opportunities.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03869-4
