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 includes six measure scores for Clinical Depression Screening and Follow-up, Standardized Transfusion Ratio, Standardized Readmission Ratios, Pain Assessment and Follow-up, National Healthcare Safety Network Healthcare Personnel Influenza Vaccination and NHSN bloodstream infection for PY 2018.
According to CMS, nearly 30% of beneficiaries with ESRD experience significant symptoms of depression, which can lead to low energy, fatigue, sleep disturbance, and anorexia. Additionally, according to Paul L. Kimmel, MD, of the Division of Renal Diseases and Hypertension at George Washington University Medical Center, depression is the most common psychological disorder in patients with ESRD.
Transfusion avoidance has been the cornerstone of anemia treatment for patients with kidney disease, direct measurement of red blood cell transfusion use to assess dialysis facility anemia management performance is reasonable. Administration of transfusions to dialysis patients reflects medical practice both within and outside the dialysis unit. Some transfusions may be deemed unavoidable and transfusion practices are subject to considerable regional variation. Reducing hospital readmission rates is a clinical and policy priority, but little is known about variation in rates of readmission after major surgery and whether these rates at a given hospital are related to other markers of the quality of surgical care.
Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tools on each visit and documentation of a follow-up plan when pain is present. This measure is to be reported at each denominator eligible visit occurring during the performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
The Advisory Committee on Immunization Practices (ACIP) recommends that all healthcare personnel (HCP) and persons in training for healthcare professions should be vaccinated annually against influenza. Persons who are infected with influenza virus, including those with subclinical infection, can transmit influenza virus to persons at higher risk for complications from influenza. Vaccination of HCP has been associated with reduced work absenteeism and with fewer deaths among nursing home patients and elderly hospitalized patients. 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.