For the 2017 ESRD Quality Incentive Program, the Centers for Medicare & Medicaid Services says tracking influenza vaccination will be in, while adequacy measures will look different.

The agency has released a proposed update to the Quality Incentive Program for dialysis facilities covering performance years 2017 and beyond that will offer a new measure for evaluating dialysis adequacy and place a bigger emphasis on making sure patients are properly vaccinated.

For payment year 2019—which reflects actual performance in 2017—CMS is proposing to remove adequacy measures for hemodialysis and peritoneal dialysis, for adults and children, and replace it with a single clinical measure.

CMS proposes the four measures in Kt/V Dialysis Adequacy would be replaced with “Delivered Dose of Dialysis above Minimum,” a single measure of dialysis adequacy assessing the percentage of all patient-months, fo pediatric and adult dialysis patients, whose average delivered dose of dialysis (either hemodialysis or peritoneal dialysis) met the specified Kt/V threshold during the performance period.

What do you think about the new dialysis adequacy measures? Send your comments to Rebecca Zumoff at

“This measure’s specifications allow the measure to capture a greater number of patients, particularly pediatric hemodialysis and peritoneal dialysis patients, than the four individual dialysis adequacy measures, and will result in a larger and broader collection of data from patients whose dialysis adequacy is assessed under the ESRD QIP,” CMS writes in the proposed rule.

The change would reduce the number of reporting and clinical measures currently in place from 16 to 12 for performance year 2017.

The new adequacy measure will be partnered with a reporting measure on influenza vaccinations and one on measuring ultrafiltration rates. For performance year 2017, CMS is proposing that dialysis facilities report an ultrafiltration rate for each qualifying patient at least once per month in CROWNWeb. CMS acknowledges that the measure is still under review by the National Quality Forum, but “we believe the measure is ready for adoption because it has been fully tested for reliability and addresses a critical aspect of patients’ clinical care not currently addressed by the ESRD QIP measure set.”

The measure would assess the percentage of patient-months for patients with an ultrafiltration rate greater than 13 ml/kg/hr.

Dialysis facilities would be scored on whether they successfully report the required data within the timeframe provided, not on the values reported.

The Full-Season Influenza Vaccination reporting measure, also still under review by the NQF, would assesses the percentage of ESRD patients greater than 6 months of age on Oct. 1 and on chronic dialysis greater than 30 days in a facility at any point between Oct. 1 and March 31 who either 1) have received an influenza vaccination; 2) were offered but declined the vaccination; or 3) were determined to have a medical contraindication.

CMS is asking for comments on the proposed changes to the ESRD Quality Incentive Program and the Prospective Payment System through Aug. 25. Comments can be submitted by:

  • sending them electronically to Follow the “Submit a comment” instructions.
  • via regular mail. Written comments should be sent to the Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1628-P, P.O. Box 8010, Baltimore, MD 21244-8010.

Download the complete proposed rule.