As part of the final rule released yesterday for the ESRD payment bundle, CMS released the final requirements for the ESRD Quality Incentive Program for 2016. The agency has added a new measure to the program for payment year 2019, while removing four measures from the program. CMS also finalized changes to certain administrative requirements and other programmatic policies.

In brief, the final rule spells out changes and additions covering calendar year 2015–2017 for the ESRD QIP.

  • The PY 2017 ESRD QIP measure set contains eight clinical measures and three reporting measures encompassing anemia management, dialysis adequacy, vascular access type, patient experience of care, infections, hospital readmissions, and mineral metabolism. CMS is also reinstating the qualifying patient attestations for the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) measure for PY 2017 and subsequent years, using the eligibility criteria finalized in the CY 2015 ESRD PPS final rule (79 FR 66170).
  • The PY 2018 ESRD measure set contains eleven clinical measures and five reporting measures encompassing anemia management, dialysis adequacy, vascular access type, patient experience of care, infections, mineral metabolism management, safety, pain management, depression management, and hospital readmissions. “This represents an evolution of the program to encompass more quality-of-life issues,” CMS wrote.

The agency said did not adopt any new measures for PY 2018 in the CY 2016 final rule. “CMS determined that the calculation previously finalized for the Pain Assessment and Follow-Up reporting measure could unduly penalize facilities that treat no eligible patients in one of the two six-month periods evaluated under this measure. Therefore, beginning with the PY 2018 ESRD QIP, if a facility treats no eligible patients in one of the two six-month periods, then that facility’s score will be based solely on the percentage of eligible patients treated in the other six-month period for whom the facility reports one of six conditions,” the agency wrote.

  • The PY 2019 ESRD measure set contains eight clinical measures and five reporting measures, encompassing anemia management, dialysis adequacy, vascular access type, patient experience of care, infections, mineral metabolism management, safety, pain management, depression management, and hospital readmissions. CMS has also replaced the four individual dialysis adequacy clinical measures (Hemodialysis Adequacy: Minimum delivered hemodialysis dose; Peritoneal Dialysis Adequacy: Delivered dose above minimum; Pediatric Hemodialysis Adequacy: Minimum spKt/V; and Pediatric Peritoneal Dialysis Adequacy) with a single clinical measure (the Dialysis Adequacy clinical measure) covering the patient populations previously captured by these four individual measures. Likewise, beginning with the PY 2017 ESRD QIP, CMS will modify the “small-facility adjuster” calculation. The rule also continues CMS’s data validation pilot program and a validation study of data used for the NHSN Bloodstream Infection in Hemodialysis Outpatients clinical measure.

The final rule will appear in the Nov. 6 Federal Register and can be downloaded here.