The Centers for Medicare & Medicaid Services issued a final rule on Oct. 28 that made changes to the ESRD Quality Incentive Program (QIP), including payment years 2019 and 2020. The final rule also updates payment policies and rates for the End-Stage Renal Disease Prospective Payment System (PPS) for 2017.
Changes to the ESRD QIP
There were no changes to the PY 2018 ESRD QIP.
CMS has created a new Safety Measure Domain as a third category of measures for PY 2019. CMS finalized the inclusion of the National Healthcare Safety Network (NHSN) Dialysis Event reporting measure (as expanded in PY 2015) into the ESRD QIP measure set for PY 2019, and then combined this measure with the existing NHSN Bloodstream Infection clinical measure in a new NHSN BSI Measure Topic, which will be the only measure topic in this new Safety Measure Domain.
The agency finalized changes to the hypercalcemia clinical measure for PY 2019 to ensure that the measure remains in alignment with the measure specifications endorsed by the National Quality Forum. These changes involve updating the measure’s technical specifications for PY 2019 and future years to include plasma as an acceptable substrate in addition to serum calcium. CMS also changed the calculation of the revised measure to include patient-months with missing values in order to minimize any incentive for a facility to avoid reporting serum calcium data.
Clinical Measures: CMS added the Standardized Hospitalization Ratio (SHR) clinical measure beginning in PY 2020.
Reporting Measures: CMS adopted a new Ultrafiltration Rate reporting measure for PY 2020. CMS also replaced the Mineral Metabolism reporting measure (based on claims data) with a new Serum Phosphorus reporting measure that uses CROWNWeb data.
In June, CMS proposed to apportion 80% of a facility’s Total Performance Score (TPS) to the Clinical Measure Domain, and 10% each to the Reporting Measure Domain and the Safety Measure Domain. In response to public comments received during the public comment period, however, CMS has not finalized this proposal. Instead, CMS will maintain the scoring methodology it finalized for PY 2019: which is to apportion 75% of a facility’s TPS to the Clinical Measure Domain, 15% of the TPS to the Safety Measure Domain, and 10% to the Reporting Measure Domain.
CMS will continue its pilot program to validate data that facilities enter into CROWNWeb. The Final Rule also increased the size of the NHSN validation study, and revised the methodology to determine whether a facility reported dialysis events for patients in accordance with the NHSN Dialysis Event Protocol.