NN&I - January 2012

Renal Policy Figure 1 The impact of achievement scores score would be 6 see formula below and Figure 1 The score for every clinical measure is the higher of the facilitys achievement score range 0 10 or improvement score range 0 9 The calculation of the improvement score is similar to that for the achievement score A few definitions help to explain improvement scoring Improvement Score Improvement Threshold This is the individual facilitys performance during the baseline period July 1 2010 to June 30 2011 Benchmark As for the achievement score benchmark the improvement score benchmark is set at the ninetieth percentile of national performance during the baseline period Improvement Range This is the range between the improvement threshold see above and the benchmark If the facility scores below the improvement threshold its improvement score for the measure is zero above the benchmark and the maximum score is nine Improvement Score A linear scale laid parallel to the improvement range with values ranging from 0 9 would determine the facilitys improvement score for the measure In the URR example if a facility had 82 of patients with URR 65 in its baseline period and 96 in the performance period and the benchmark was 100 then its improvement score would be seven formula and figure 1 Since the improvement score is higher than the achievement score calculated above the performance score would be the higher of the two or seven Each of the three clinical measures can produce a score of 0 10 higher of the achievement or improvement score Together the maximum clinical score can be between 0 and 30 and this will result in 90 of the total performance score with the reporting measures making up the other 10 QIP Formulas Achievement Score 9 x facility rate in performance period achievement threshold benchmark achievement threshold 05 Improvement Score 10 x facility rate in performance period facility rate in baseline period benchmark facility rate in baseline period 05 Penalty vs reward Comparing the QIP to incentives in hospital care A major change in the payment year 2014 ESRD QIP is a significant move towards alignment with the methods of the Medicare Hospital Value Based Purchasing Program VBP The Hospital program currently underway gradually increases a withhold on every diagnostic related group payment a capitated rate for hospital procedures from 1 to a maximum of 2 in 2017 The withheld amount can be earned back based on hospital performance The ESRD QIP program moves towards using a similar methodology for scoring performance using achievement and improvement scores and a similar linear scaled scoring method Both programs lead to a final Total Performance Score that determines payment Both use similar terminology such as achievement thresholds benchmarks and achievement ranges The mathematical formulas for determining scoring are very similar A major difference is that the ESRD QIP is purely punitive from the payment standpoint The dialysis facilities can at best hope to maintain their designated payments at worst they will lose up to 2 of the payment In contrast The Hospital VBP withholds 2 from all hospitals and then pays the entire amount back Based on an individual hospitals performance it may have 2 of payments withheld but earn significantly more than that back Therefore it is a truer pay for performance program offering positive incentives as well as potential penalties Nephrology News Issues January 2012 Subscribe to our free eNewsletter at www NephrologyNews com 24