Although the dialysis community still awaits revisions from the Centers for Medicare & Medicaid Innovation Center to the application process for the Comprehensive ESRD Care Model demonstration—originally expected to launch in January—an agency hired by CMS has released draft clinical measures that participants would need to follow if they join the five-year project.

(USRDS contract awarded to UM Kidney Epidemiology and Cost Center)

The measures, which are open for public comment through March 15, were developed by a technical expert panel (TEP) assembled by IMPAQ International, a consulting firm hired by CMS to help manage its quality-directed projects. TEP members included the chief medical officers of DaVita Healthcare Partners and Fresenius Medical Care North America, as well as other nephrologists, nephrology nurses, dialysis patients, and representatives of advocacy groups.

The TEP had to develop and recommend measures that met the following priorities, according to IMPAQ:

  • Appropriate to the health issues of dialysis patients
  • Effective for quality of care monitoring and program oversight
  • Inclusive of process and outcome measures that will enable a robust evaluation of patient, provider and delivery system outcomes
  • Conducive to use across clinical methods, modalities, and care settings
  • Effective for incentivizing better care, better health, and lower costs across Medicare Part A, Part B, Part D and Medicaid programs

The measures had to also include medication protocols and be “straightforward to operationalize and measure.” The already established ESRD Quality Incentive Program (QIP) clinical measures will be included, IMPAQ said.

In general, the recommended measures from the TEP cover patient satisfaction; extensive preventive efforts in managing diabetes; tracking the use of ACE inhibitors or ARB therapy for managing heart disease, along with the use of beta blockers to help manage coronary artery disease; use of a dialysis facility risk-adjusted standardized mortality ratio; tracking immunizations and vaccinations, tobacco use, and screening for clinical depression, and development of a standardized hospitalization ratio and  readmission ratio for dialysis facilities.

The complete list, along with other measures discussed and under consideration by IMPAQ, can be downloaded here. IMPAQ will make recommendations to CMS, which will determine a final measure set for inclusion in the initiative.

Few applicants stall ACO demo

CMS had planned to launch the demonstration in January after it issued a series of extensions granted to applicants and adjustments to the requirements in an effort to appeal to more dialysis providers. After getting few applicants to meet its planned 10-12 awardees, CMS abruptly announced in late October that it would re-evaluate the application process and re-open requests for proposals.

CMS acknowledged in delaying the demonstration that it needed to succeed in “creating opportunities for small dialysis organizations to participate.”  Small- to mid-sized providers said the demonstration rules of participation make it difficult for them to attract partners to form an ESCO – an ESRD Seamless Care Organization – to manage the demonstration and succeed alongside larger dialysis organizations.

The aim of the demonstration is to test whether dialysis providers can succeed at managing a dialysis patient’s global health care needs, improve outcomes, and reduce Medicare costs. The reward for providers would be sharing in the savings with the ESCO partners and Medicare.

To submit comments on the quality measures, use the IMPAQ survey tool, available here.