ESRD Quality Incentive Program (QIP)
Overview
The Centers for Medicare & Medicaid Services (CMS) has completed implementation of the first year of the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) designed to encourage the delivery of high-quality services in dialysis facilities. The ESRD QIP is one of several pay-for-performance or “value-based purchasing” initiatives that CMS has undertaken to transform the healthcare payment system to one that considers the quality of services provided to beneficiaries, not just the quantity of services provided.
Beginning in January 2012, a portion of each dialysis facility’s payment will depend on how well that facility meets standards for specific measures of quality, based on measures and standards previously specified by law and in federal regulation. Dialysis facilities that do not meet or exceed the standards may have their claims payments for 2012 reduced up to two percent.
Also starting in 2012, each dialysis facility must post a Performance Score Certificate that documents the facility’s performance on the ESRD QIP including their Total Performance Score, scores on individual measures, and comparisons to the national average. Facilities must display their Performance Score Certificate within five business days of receiving notice from CMS that the certificate is available. The certificate must be posted for the entire year (January 1, 2012-December 31, 2012) in an area where it is easily visible to beneficiaries and their families or caregivers. These certificates will be replaced annually.
Performance Report Deployment - A summary table illustrating performance year and measures calculated by percent of patients above or below specific thresholds
Performance Score Certificate Frequently Asked Questions for Payment Year 2012
What is the Payment Year 2012 Performance Score Certificate?
The Payment Year (PY) 2012 Performance Score Certificate is a two-page document intended to inform patients and their families how a dialysis facility performed in the first year of the ESRD QIP. It must be posted in an area easily visible to patients and their families.
What is the source of the scores that appear on the Performance Score Certificate?
The scores on the Performance Score Certificates for PY 2012 are based on quality measures and standards previously specified by law and in federal regulation. For PY 2012, CMS scored facilities based on their performance during calendar year 2010 on two anemia management measures and one hemodialysis adequacy measure:
- Percentage of Medicare patients with an average hemoglobin less than 10. grams per deciliter (g/dL)
- Percentage of Medicare patients with an average hemoglobin greater than 12. g/dL
- Percentage of Medicare patients with a median Urea Reduction Ratio (URR) equal to or greater than 65 percent
When will facilities receive their Performance Score Certificate?
CMS will electronically notify facilities that the Performance Score Certificates are available for downloading in December 2011. Facilities will download the certificate from http://www.dialysisreports.org/. Each facility is responsible for printing the Performance Score Certificate and posting it in a noticeable location where patients and caregivers can view it.
When should facilities begin displaying the Performance Score Certificate?
Facilities must display the Performance Score Certificate no later than five business days from when CMS makes the certificate available. It must be displayed continuously during the calendar year.
Are there any special instructions about displaying the Performance Score Certificate?
Facilities are prohibited from altering the size or content of the Performance Score Certificate in any way (including changing the font size). It must be printed on two pieces of plain, white or light-colored paper of at least 8 ½ by 11 inches. Both pages must be displayed together.
How long does a facility need to display the Performance Score Certificate?
The Performance Score Certificates must be displayed for the duration of Calendar Year 2012. Certificates will be replaced annually.
What if the facility’s Payment Year 2012 Performance Score Certificate is lost or destroyed?
If a Performance Score Certificate is lost, removed, destroyed, or defaced, the facility is responsible for replacing the certificate with a new copy as soon as possible by reprinting it by again after logging on to the http://www.dialysisreports.org/ Web site. The certificate will be available throughout the entire 2012 calendar year on this Web site.
Will these Performance Score Certificates be available to patients and the public through other sources?
Yes; starting in December 2011, the Performance Score Certificates will also appear on the CMS Dialysis Facility Compare Web site at http://www.medicare.gov/Dialysis/.
Where can facilities find the details of how a facility’s scores were calculated?
CMS has provided each facility with a draft and final Performance Score Report that facilities had an opportunity to preview and download. The Performance Score Report and a separate methodology guide contain information on calculation methods. Additional information is available at http://www.dialysisreports.org/Methodology.aspx. A sample Performance Score Report can be found at http://www.dialysisreports.org/pdf/esrd/public/SamplePSR.pdf . A guide to the Performance Score Report can be found at http://www.dialysisreports.org/pdf/esrd/public/Guide_to_the_PY_2012_ESRD_QIP_PSR.pdf
Do the Performance Score Certificates indicate the quality of care a facility provides?
The first year of the ESRD QIP evaluated three measures which represented clinical standards in place during 2010. Because these measures do not represent the totality of care provided by a facility, the results should be interpreted in context with other available information. In future years, CMS plans to expand the program to include other measures that reflect quality dialysis care.
As a patient, what does the Performance Score Certificate mean to me?
The purpose of the ESRD QIP is to improve the quality of dialysis care and produce better outcomes for beneficiaries. The Performance Score Certificate provides a picture of how well your facility performed on specific measures and may help inform the decisions you make about your care. We encourage you to discuss these results with your providers.
What resources are available if facilities and Networks cannot answer a patient’s questions about the Performance Score Certificate?
Facilities should contact the local ESRD Network for any unresolved questions.
What resources are available to answer facilities questions?
- ESRD QIP ODF Webcast (July 14, 2011)
https://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp#TopOfPage - Link to ESRD PPS 2012 Final Rule (ESRD QIP Measures for PY 2012) (August 12, 2010): http://edocket.access.gpo.gov/2010/pdf/2010-18466.pdf
- ESRD QIP 2012 Final Rule (January 5, 2011)
http://www.gpo.gov/fdsys/pkg/FR-2011-01-05/pdf/2010-33143.pdf - ESRD Fact Sheet (December 29, 2010)
https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3889 - PPS/ESRD Press Release (December 29, 2010)
http://www.cms.gov/apps/media/press/release.asp?Counter=3888