NN&I - January 2012

Renal Policy January 2012 Nephrology News Issues 29 2013 QIP scores Furthermore anemia management and adequacy remain as measures in 2014 While both areas are undeniably important parts of the care of dialysis patients we question whether the time will come soon to retire these measures Performance is nearly maximized is there really room for improvement Data from the Dialysis Facility Compare website shows that distribution of URR performance is strongly skewed and that 90 of facilities have at least 90 of their patients achieving URR 65 Furthermore variation between facilities is slight such that differences of as little as one patient can result in financial penalties Maintaining measures where the range of achievement is very narrow and performance is high will lead to unnecessary penalties and needless year to year liability in facility quality scores There are meaningful precedents for evolution of quality metrics in 2007 the National Committee for Quality Assurance decided to retire the hospital quality metric for betablocker use within seven days of hospital discharge for acute myocardial infarction The stated reason for this decision was near universal achievement 94 96 of this metric with little variance among health plans and thus little utility as a quality measure to differentiate plans Similarly we hope that the QIP evolves in favor of measures that can push dialysis care forward improving outcomes and optimizing CMS return on investment As the bundled payment system and the QIP progress hand in hand CMS and providers will have an opportunity to select the most meaningful quality measures It will also be critically important to watch closely for any adverse consequences and for any shifts towards unproven treatments that have the potential to harm the patient We www NephrologyNews com envision that future measures will focus on cardiovascular disease fluid management infection rates dialysis modality patients experience of care as well as dialysis access If future performance measures are based on solid medical evidence and data and can actually be controlled by the dialysis facility in a timely manner the future QIP can have a valuable impact on the health of dialysis patients Resources Roadmap for implementing value driven health care in the traditional Medicare fee for service program Centers for Medicare Medicaid Services Published January 16 2009 Lee TH Eulogy for a quality measure N Engl J Med 2007 357 1175 1177 How you can win in 2012 and lose in 2013 A case study Facility A was opened in 2006 In 2007 20 Medicare patients were included in the baseline period for the URR measure for the 2010 QIP Ninety five percent 19 20 of patients had URR over 65 less than the performance standard of 96 Therefore the facilitys performance standard was its own 2007 performance In 2010 the performance period for the 2012 QIP performance was 94 31 33 for the URR metric Thus performance was below the standard yielding a point penalty This facility met performance standards for hemoglobin two points deduction from the total QIP score resulted in a 0 payment reduction In 2011 the performance period for the 2013 QIP performance was 94 33 35 for the URR metric Thus performance was below the standard yielding a point penalty This facility met performance standards for hemoglobin Due to a more stringent penalty scale two points deduction from the total QIP score resulted in a 1 payment reduction For CY 2012 performance standards have not yet been published There will be a sliding scale type score with facilities graded on achievement and improvement Based on the estimated achievement range of 91 to 100 for this measure this facility would likely incur some point reduction with either calculation Whether this translates to a financial penalty will depend on performance on other measures since this measure accounts for only 30 of the total Time Period Patients in Facility Number with URR 65 Percentage with URR 65 QIP Penalty CY 2007 20 19 95 Performance Standard Year CY 2010 33 31 94 2012 QIP 0 CY 2011 35 33 94 2013 QIP 1 July 1 2010 to 36 34 94 June 30 2011 Performance Standard Period for 2014 QIP CY 2012 37 35 95 Performance Standards not yet established but likely to incur some degree of Sliding Scale Points reduction on both Achievement and Improvement Scores