When the Centers for Medicare & Medicaid Services first proposed its End-Stage Renal Disease Quality Incentive Program (QIP) five years ago, Kidney Care Partners was supportive of the effort. And while we continued to support the overall intent of the QIP and the foundation it has built for significant improvements, our leadership also believed that the kidney community had a wealth of knowledge, experience, and strategic recommendations that could guide greater quality improvement. KCP members agreed that kidney care quality overall would benefit from a blueprint – or roadmap – to help guide clinicians, providers, and regulators to ensure that patients’ lives are improved by the technically complex and costly therapy that they are receiving.

Launching the Blueprint

Launching the Blueprint

The recent release of the report, “A Strategic Blueprint for Advancing Kidney Care Quality,”culminated a yearlong effort by 33 sponsoring organizations – some of the nation’s top medical and policy experts from KCP’s diverse membership – to identify key areas for advancing improvement in the delivery of quality kidney care. The Blueprint identified four patient-centric goals:

  • Improve patient survival
  • Reduce hospitalizations
  • Improve health-related quality of life
  • Improve patient experiences with care

The creation of the Blueprint forces community stakeholders to think differently about quality, building upon the existing foundation while identifying the gaps across the care model and putting forth strategic recommendations for filling those gaps. And by articulating this new view of quality in the ESRD program, KCP members are hopeful that the Blueprint development will reframe the quality discussion to focus on the most important drivers of quality, including:

  • The most effective clinical practices that lead to positive outcomes.
  • The key areas to invest in research.
  • How to foster a system of innovation.
  • How to ensure that federal policies help drive quality to the next level.

 

 

The QIP and the Blueprint

The KCP Blueprint focuses on nine “domains” for kidney care quality.

  • Care coordination
  • Disease management
  • Infrastructure
  • Palliative and end-of-life care
  • Patient engagement and education
  • Patient satisfaction and patient experience with care
  • Pediatric-specific issues
  • Quality of life
  • Safety

Our KCP membership sees the Blueprint as a guidepost for public and private sector stakeholders to expand upon and/or identify their own priorities. Following the development of the blueprint, KCP’s next step is a collaborative initiative to develop facility-level performance measures to advance change. The reconstitution of the Kidney Care Quality Alliance (KCQA), an organization of community leaders, will develop quality performance measures for dialysis facilities. Those who have been tracking quality measure development activities might recall that KCP launched a similar effort in 2005 that led to the development of quality measures eventually endorsed by the National Quality Forum.

CMS has always expressed a desire to work with community stakeholders in the agency’s own measure development, and we commend them for that. We believe that the renal community is in the best position to create measures that are not only relevant, practical, and proven to drive better outcomes, but also measures where data are available, evidence is appropriate, and collection, aggregation, and analysis are possible.

We share the agency’s desire to continue to raise the quality bar, and we look forward to working collaboratively with agency officials on new measure development through the KCQA.

Without question, the Blueprint creates a different quality paradigm. It is a multi-stakeholder, consensus document that provides a near-term roadmap on key actions that, if undertaken through collaboration and partnership, can result in the significant improvement in the delivery of quality kidney care. The Blueprint is not a substitute for the QIP, but rather a tool to focus the community on selecting appropriate measures that are evidence-based and can be used within the QIP to drive quality. With the blueprint in hand and the reconstitution of the KCQA, KCP looks forward to finding the answers with the broader community’s input and working with government officials to enact real change.