NN&I - January 2012

Renal Policy Table 2 Sample dialysis unit Hgb 12 g dL URR 65 National Standard 2009 14 97 Sample Dialysis Unit 2011 16 96 Difference 2 1 Point Deduction 4 2 Difference x 2 Sum of Point Deduction 6 Total Score 30 Point Deduction 24 consists of two areas of substantial change first in the extent of the quality measures and second a dramatic and sweeping change in scoring methodology For the quality measures there will be two categories clinical indicators representing 90 of the total score and reporting measures comprising the remaining 10 Clinical quality indicators The first clinical measure the anemia metric of percentage of patients with Hgb 12 g dL remains unchanged It is ironic and perhaps disappointing that given the importance of anemia the only quality measure assesses for overtreatment CMS had proposed that the dialysis adequacy indicator the second measure would change this year from URR to Kt V but in the final rule the URR measure was retained The standard will again be the percentage of hemodialysis patients with URR 65 The third clinical quality domain vascular access type is new for this year The goal is to promote arteriovenous fistulas AVF while discouraging use of dialysis catheters The specific measures are the percent of hemodialysis patients using an AVF with two needles during the last treatment of the month the percent of hemodialysis patients with a central venous catheter used for the last treatment of the month and for 90 days prior to the last dialysis session without a fistula or graft in place The actual calculation will be based on the number of patient months with a fistula or catheter divided by total patient months Two additional clinical measures were proposed but excluded from the final rule vascular access infections and the standardized hospitalization ratio In addition to the three clinical quality measures three reporting measures have been added These will together comprise 10 of the total quality score The first measure is reporting of dialysis safety events currently dialysis related infections to the National Healthcare Safety Network NHSN a program administered by the Centers for Disease Control and Prevention The second is an attestation of administering the In Center Hemodialysis ICH Consumer Assessment of Healthcare Providers and Systems ICH CAHPS a patient satisfaction survey The final reporting measure is an attestation that calcium and phosphorus have been tested on at least a monthly basis Since the clinical measures comprise 90 of the total score and the reporting measures 10 the impact of each individual measure can readily be determined Each of the three clinical measures is worth one third of 90 or a 30 contribution to the total performance score Similarly each reporting measure contributes 33 Since the maximal payment reduction is 2 each clinical and reporting measure can have an effect of up to 06 and 007 respectively The base dialysis treatment payment for 2014 is yet to be determined If we assume an amount of approximately 235 per hemodialysis treatment the 2 at risk per treatment is 470 Each clinical measure puts up to 141 at risk per treatment and each reporting measure approximately 016 For a dialysis unit with 12 chairs and three shifts per day performing 11000 treatments per year the total risk will be approximately 52000 see Table 3 The impact of the revised scoring system The scoring system for the QIP in payment year 2014 performance year 2012 becomes significantly more complex than the two previous years Table 3 QIP for payment year 2014 performance year 2012 Sample dialysis unit 72 patients 11000 treatments per year Approximate 2014 base revenues 2600000 QIP 2 at risk 52000 Clinical measures contribution to risk 90 Percentage Financial Hgb 12 g dL 30 15600 URR 65 30 15600 Vascular access type 30 15600 Reporting measures contribution to risk 10 NHSN reporting 333 1733 Patient satisfaction measurement 333 1733 Calcium and phosphorus measurement 333 1733 Nephrology News Issues January 2012 Subscribe to our free eNewsletter at www NephrologyNews com 22