Medicare payments for End Stage Renal Disease rely on a value-based purchasing (VBP) system known as the Quality Incentive Program (QIP). Today I review proposed changes to the QIP that will effect the payments for dialysis centers in 2013 and 2014.
Payment Year 2013
Two measures have been adopted for the payment year (PY) 2013 ESRD QIP
- Percentage of patients with hemoglobin levels greater than 12 g/dL (Hemoglobin Greater Than 12 g/dL) Lower percentage indicates better care
- Percentage of patients with a Urea Reduction Ratio (URR) of 65% or greater (Hemodialysis Adequacy) Higher percentage indicates better care
To qualify for a score, facilities must have at least 11 patients eligible for each measure.
Each facility that meets or exceeds performance standard for a measure receives 10 points (for each measure). For other facilities, the scoring is more complex.
- Facility does not meet the performance standard for a measure: 2 points subtracted from 10 points for every 1% below the performance standard
- Total Performance Score = Sum of the Two Measure Scores x 1.5
The payment reduction for payment year 2013 depend on the total performance score (TPS) as follows:
- 30 points: 0%
- 26-29 points: 1.0%
- 21-25 points: 1.5%
- <21 points: 2.0%
Payment Year 2014
In PY 2014, the ESRD QIP will add one clinical measure (vascular access type (VAT)) and three reporting measures. The reporting measures include:
- Dialysis event data submission to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) system
- Patient Satisfaction (measured by In-center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey)
- Monthly mineral metabolism monitoring (serum calcium and serum phosphorus)
For PY 2014, there is a significant lag between when the data are collected and when payments are adjusted. PY 2014 is based off a performance period of CY2012 and a baseline period of July 1, 2010 to June 30, 2011. The baseline data is used to measure an improvement score.
The payment reduction for payment year 2014 depend on the total performance score (TPS) as follows:
- 53-100 points: 0%
- 43-52 points: 0.5%
- 33-42 points: 1.0%
- 23-32 points: 1.5%
- <23 points: 2.0%
The scoring system and performance standards are outlined in more detail here.