New ESRD Quality Initiative Program Is Launched

The Centers for Medicare & Medicaid Services (CMS) has launched a new quality initiative for Medicare-certified renal dialysis facilities. The End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) will begin Jan. 1, 2012. Facilities that do not meet quality measures established by CMS may be subject to a payment reduction of up to 2 percent on Medicare claims, according to a July 14 ESRD QIP fact sheet, issued by CMS.

The ESRD QIP was designed to encourage high quality care for dialysis patients. According to the fact sheet, “Under the ESRD QIP, CMS awards points to facilities based on their performance on three quality of care measures—two anemia management measures and one dialysis adequacy measure.”

Specifically, CMS will assess the percentage of patients with a hemoglobin (Hb)<10 g/dL, the percentage of patients with a Hb>12 g/dL (low percentage is desired for both Hb measures), and the percentage of patients with a urea reduction ratio (URR) over 65 percent (high percentage is desired). CMS will compare each facility’s performance to a performance standard to calculate scores for each measure. The individual measure scores will be weighted and combined to calculate the facility’s total performance score. Facilities with a total performance score below 26 (out of 30 possible) points will have their Medicare payments for dialysis services delivered during payment year 2012 reduced on a sliding scale. You can find more information on how the scores are calculated by viewing the ESRD QIP 2012 final rule.

Once finalized, facility scores will be made available to the public on the Dialysis Facility Compare website. Facilities will be able to download their scores near the end of 2011. By law, facilities must display their performance score certification in a prominent location for all of 2012.

CMS allowed for a preview period of July 15 – Aug.15, during which facilities were able to review their current scores and submit questions to CMS.

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