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 givers, and facility staff about Dialysis Facility Compare, QIP, and supporting patients, family, and care givers as engaged consumers.
The Network is charged with collaborating with the State Survey Agency (SSA) to define oversight for compliance with posting the PSR.
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:
ESRD QIP Program Process
Summer: CMS publishes a Proposed Rule via Notice of Proposed Rulemaking (NPRM) in the Federal Register
The public has a 60-day period to comment
Fall: CMS takes public comment into consideration and publishes a Final Rule in the Federal Register
ESRD QIP Rulemaking
Notice of Proposed Rulemaking for PY 2017 and 2018
ESRD Quality Incentive Program Educational Resources
MLN Connects Payment Year 2016 Final Rule
QIP & ESRD Data Collection Systems Presentation
Information on Current ESRD QIP Measures and Specifications:
What resources are available to answer facilities 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.
Performance Score Preview Period: Dialysis Reports, State and Region Profiles
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.