Quality of Care

Establish Quality Measures

Reporting Outcomes

Engaging Patients and Families
Improving Quality of Life

Pay for Performance and the Informed Consumer

Pay for Performance and Informed Consumer

The ESRD Quality Incentive Program (ESRD QIP)

The Medicare ESRD Program instituted legislatively mandated changes in 2011 for dialysis services. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare’s first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program.

Facilities that do not meet or exceed performance standards will be subject to a payment reduction of up to two percent depending on how far their performance deviates from the standards. These standards and measures will be made public for people to compare facility performance when choosing dialysis centers.

The ESRD QIP payment adjustments will apply to payments for outpatient maintenance dialysis items and services furnished to Medicare beneficiaries by ESRD.

The Network’s Role

The Network is charged with supporting the QIP, educating Patient/Family/Care Partners and facility staff about Dialysis Facility Compare, the QIP, and supporting Patients/Family/Care Partners as engaged consumers.

The Network is charged with collaboration with the State Survey Agency (SSA), and the Network is working with the SSA to define oversight for compliance with posting the PSR. (General Requirements)

For detailed information on the QIP, performance and reporting measures by year and methodology, please go to Medicare’s ESRD Quality Incentive page.

QIP Finalized PY 2017 Clinical and Reporting Measures
QIP Finalized PY 2018 Clinical and Reporting Measures

CMS fact sheets:
How QIP Affects Patients
How QIP Affects Dailaysis Facilities

Medicare Learning Network Educational Webinars and Recordings

Other QIP Resources:

  • Nephrology News & Issues ESRD Payment Bundle and QIP News Stories (2010-present)
  • 2014 QIP CMS press release issued 11/22/2013

ESRD QIP Program Process

  • Summer: CMS publishes a Proposed Rule via Notice of Proposed Rulemaking (NPRM) in the Federal Register
  • Public has a 60-day period to comment
  • Fall: CMS takes public comment into consideration and publishes a Final Rule in the Federal Register

ESRD QIP Rulemaking

Notice of Proposed Rulemaking for PY 2017 and 2018

ESRD Quality Incentive Program Educational Resources

MLN Connects Payment Year 2016 Final Rule

QIP & ESRD Data Collection Systems Presentation

Information on current ESRD QIP measures and specifications

What resources are available to answer facilities questions?

Performance Score Preview Period: www.DialysisData.org

The Patient as Consumer: Dialysis Facility Compare

Performance Score Report (PSR)

The first PSRs were issued to Dialysis Providers in December, 2011. The PSR is updated annually, and Providers must post the signed PSR in a public area of their facility.