The Centers for Medicare & Medicaid Services (CMS) administers the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) to promote high-quality services in outpatient dialysis facilities treating patients with ESRD. As the first of its kind in Medicare, this program changes the way CMS pays for the treatment of patients with ESRD by linking a portion of payment directly to facilities’ performance on quality of care measures. These types of programs are known as “pay-for-performance” or “value-based purchasing” (VBP) programs.
The ESRD QIP will reduce payments to ESRD facilities that do not meet or exceed certain performance standards. The maximum payment reduction CMS can apply to any facility is two percent. This reduction will apply to all payments for services performed by the facility receiving the reduction during the applicable Payment Year (PY).
National Healthcare Safety Network (NHSN) provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts and ultimately eliminate Healthcare-Associated Infections (HAI). In addition, NHSN allows healthcare facilities to track blood safety errors and important healthcare process measures such as healthcare personnel influenza vaccine status and infection control adherence rates. NHSN enables healthcare facilities to collect and use data about HAIs, adherence to clinical practices known to prevent HAIs, the incidence or prevalence of multidrug-resistant organisms within their organizations, trends and coverage of healthcare personnel safety and vaccination, and adverse events related to the transfusion of blood and blood products.
In the NHSN Dialysis Event Protocol, the National Healthcare Safety Network (NHSN) Bloodstream Infection (BSI) in Hemodialysis Outpatients Measure is the standard for evaluating the number of positive blood cultures observed by a facility. Although other dialysis event types are reported to NHSN and calculated from the data, the BSI measure only assesses the number of positive blood cultures reported by a facility using a standardized infection ratio (SIR). Use of this measure has been demonstrated to help identify outbreaks of bloodstream infections and to stimulate improvements in vascular access care and other infection control practices that have led to subsequent reductions in bloodstream infections.
The foundation, principles, and mechanisms guiding the ESRD QIP will remain the same over time, but the program’s specific quality measures, standards, weights and formulas will change from year to year.