Quality of Care

Establish Quality Measures

Reporting Outcomes

Engaging Patients and Families
Improving Quality of Life

Pay for Performance and the Informed Consumer

Pay for Performance and Informed Consumer

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.

QIP Finalized PY 2017 Clinical and Reporting Measures
QIP Finalized PY 2018 Clinical and Reporting Measures

CMS fact sheets:
How QIP Affects Patients
How QIP Affects Dialysis Facilities
Medicare Learning Network Educational Webinars and Recordings

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
                   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:

  End-Stage Renal Disease (ESRD) Quality Initiative
  End Stage Renal Disease (ESRD) Quality Measures
  Reviewing Your Facility’s PY 2015 Performance Data

What resources are available to answer facilities questions?

  ESRD QIP Webpage
  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: 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.