The ESRD Quality Incentive Program (ESRD QIP)
The Medicare ESRD Program instituted legislatively mandated changes in 2011 for dialysis services. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare’s first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program.
Facilities that do not meet or exceed performance standards will be subject to a payment reduction of up to two percent depending on how far their performance deviates from the standards. These standards and measures will be made public for people to compare facility performance when choosing dialysis centers.
The ESRD QIP payment adjustments will apply to payments for outpatient maintenance dialysis items and services furnished to Medicare beneficiaries by ESRD.
The Network’s Role
The Network is charged with supporting the QIP, educating Patient/Family/Care Partners and facility staff about Dialysis Facility Compare, the QIP, and supporting Patients/Family/Care Partners as engaged consumers.
The Network is charged with collaboration with the State Survey Agency (SSA), and the Network is working with the SSA to define oversight for compliance with posting the PSR. (General Requirements)
For detailed information on the QIP, performance and reporting measures by year and methodology, please go to Medicare’s ESRD Quality Incentive page.
Other QIP Resources:
- Nephrology News & Issues ESRD Payment Bundle and QIP News Stories (2010-present)
- 2014 QIP Final Rule and CMS press release issued 11/22/2013
ESRD QIP Program Process
- Summer: CMS publishes a Proposed Rule via Notice of Proposed Rulemaking (NPRM) in the Federal Register
- Public has a 60-day period to comment
- Fall: CMS takes public comment into consideration and publishes a Final Rule in the Federal Register
What resources are available to answer facility staff questions?
- ESRD QIP Webpage
- ESRD QIP FAQs
- Performance Score Certificate FAQs
- Performance Measures/Payment Reductions– A summary table illustrating performance year and measures calculated by percent of patients above or below specific thresholds and the payment reductions associated with point differences.
- Patient Poster
- Patient Brochure
Performance Score Preview Period: www.DialysisData.org
The Patient as Consumer: Dialysis Facility Compare
Performance Score Report (PSR)
The first PSRs were issued to Dialysis Providers in December, 2011. The PSR is updated annually, and Providers must post the signed PSR in a public area of their facility.