NN&I - January 2012

Renal Policy The QIP Will it improve dialysis care Editors note although the final rule for the Quality Incentive Program was released Nov 1 concerns remain in the renal community over its goals The series of articles that make up our cover story this month review the programs structure and look closely at how the QIP expects to improve quality An overview Steven Fishbane MD Ilene Miller MD Helen Danko RN Naveed Masani MD Abstract The Centers for Medicare Medicaid Services End Stage Renal Disease Quality Incentive Program 1 is a pay for performance initiative that imposes dialysis payment reductions of up to 2 for suboptimal quality In payment years 2012 and 2013 the methodology is simple a point system based on performance in dialysis adequacy and anemia In payment year 2014 performance period begins Jan 1 2012 the QIP changes substantially with a methodology that more closely resembles the Medicare Hospital Inpatient Value Based Purchasing Program Succeeding with the QIP will require both providing high quality care for a wider variety of measures and a clear and complete understanding of the program structure and the new scoring methodology In this review we discuss the QIP with a comprehensive explanation of measures and scoring procedure Introduction CMS has taken a progressively more engaged role in promoting quality care for patients with end stage renal disease Starting with public reporting of quality metrics through the CMS Dialysis Facility Compare website to the initiation of the ESRD QIP the first nationally standardized pay for performance program in American health care the role of CMS has evolved The legislatively mandated QIP is intended to promote ESRD patient health by imposing dialysis payment reductions for quality performance that does not meet certain CMS designated standards The QIP in payment year 2012 and 2013 The initial QIP payment year 2012 is based on dialysis quality performance from 2010 The assessment of quality is based on two anemia measures percentage of patients with Hgb 10 g dL 50 of total score percentage of patients with Hgb 12 g dL 25 and dialysis adequacy based on percentage of patients with urea reduction ratio URR 65 25 Scoring is based on a 0 30 scale with progressive reduction in payment as scores decrease The methodology for payment year 2013 performance period 2011 remains fairly simple The payment reduction will again be based on performance in anemia and dialysis adequacy The adequacy measure remains URR 65 representing 50 of the total score The anemia measure of percentage of patients with Hgb 10 g dL will be retired in a controversial move based on recent U S Food and Drug Administration labeling changes for erythropoiesis stimulating agents The remaining anemia measure will be the percentage of patients with Hgb 12 g dL accounting for the residual 50 of the total performance score The performance standard will be based on national results for 2009 Hgb 12 g dL 14 of patients and URR 65 97 of patients A dialysis units performance in calendar year 2011 will be compared with the lower of the 2009 national standards or the dialysis units own performance in 2007 For each percentage point in which the dialysis unit underperforms the standard two points will be deducted from the total performance score The maximum score of 30 is achieved if performance exceeds the standards a score below 30 results in a payment reduction and scores of 20 or less result in loss of the maximal 2 see Table 1 In Table 2 we show the performance of a sample dialysis unit with 16 of patients with Hgb 12 g dL and 96 of patients with URR 65 Table 1 PY 2013 total performance score and percentage of payment reduction 30 points No reduction 26 29 points 1 reduction 21 25 points 15 reduction 20 points or less 2 reduction The QIP in payment year 2014 On Jan 1 the performance period began for the ESRD QIP payment year 2014 The proposed QIP for this year Drs Fishbane and Miller and Ms Danko are with the North Shore LIJ Health System Great Neck N Y and the Hofstra North Shore LIJ School of Medicine Dr Masani is with the Winthrop University Hospital Mineola N Y Nephrology News Issues January 2012 Subscribe to our free eNewsletter at www NephrologyNews com 20