In a move that dramatically changes how it pays end-stage renal disease facilities, the Centers for Medicare & Medicaid Services on Wednesday issued a final rule that will allow payment adjustments based on how well facilities meet dialysis performance standards.
The ESRD Quality Incentive Program is designed to promote high-quality dialysis services at Medicare facilities by linking CMS payments directly to facility performance on quality measures. By doing this, the QIP changes its traditional fee-for-service payments for dialysis that rewarded volume of service over quality.
CMS Administrator Donald Berwick lauded the ESRD QIP as "a landmark advance for improving the quality and safety of care that Medicare beneficiaries receive while on dialysis treatment."
"Since most patients with ESRD are also Medicare beneficiaries, the ESRD QIP is an especially powerful tool in transforming care in America's dialysis centers," he said.
The potential savings to Medicare and improved outcomes for patients are not insignificant. Roughly 350,000 people in the United States are receiving treatment for ESRD under Medicare, with a total annual cost approaching $9 billion.
The move to a pay-for-performance model for ESRD treatment comes on the heals of previous CMS efforts in a variety of settings that pay for reporting of quality measures. CMS is using its demonstration authority to test whether pay-for-performance can improve the quality of care in hospitals and physicians' offices.
The ESRD QIP moves it beyond a demonstration to a permanent pay-for-performance program that could affect payments to all dialysis facilities.
"For over 30 years, Medicare has been monitoring quality for patients with ESRD," said Berwick. "The new ESRD QIP allows us to build up from that foundation a program that aligns payment for dialysis treatment with the outcomes that matter most to patients."
The ESRD QIP also supports the transition of ESRD payments to a new ESRD Prospective Payment System. While the ESRD PPS is designed tol promote the efficient provision of care to patients with ESRD, officials said, the ESRD QIP will help ensure that facilities provide high quality, patient-centered care.
The ESRD QIP was mandated by the Medicare Improvements for Patients and Providers Act of 2008 as a companion to the ESRD PPS. In the ESRD PPS final rule, issued in 2010, CMS finalized three initial measures set during the first program year. Two are designed to assess whether patients' hemoglobin levels are maintained in an acceptable range, while the third measures the effectiveness of the dialysis treatment in removing waste products from patients' blood. The three measures were chosen because they represent important indicators of patient outcomes and quality of care.
The final rule establishes the ESRD QIP performance standards, sets out the scoring methodology CMS will use to rate providers' quality of dialysis care and establishes a sliding scale for payment adjustments based on the facility's performance.
In future years CMS may add quality measures and establish additional performance standards that facilities will need to meet to receive full payment for the services they furnish to Medicare beneficiaries.
To view the final rule go to www.ofr.gov/inspection.aspx#special under Special Filings.