As part of releasing the proposed rule for the End-Stage Renal Disease Program Prospective Payment System, or ESRD bundle, CMS has also released changes to the End-Stage Renal Disease Quality Incentive Program for 2014. Nine of the 10 measures CMS is currently using to gauge clinical outcomes in dialysis patients will remain intact.

“We believe that, collectively, these measures will continue to promote improvement in dialysis care in the PY 2016 ESRD QIP and in future payment years,” CMS said in the proposed rule. CMS is also following through on a plan last year to begin reviewing clinical outcomes for peritoneal dialysis and pediatric dialysis patients.

Proposed QIP measures for 2014

Following is a list of newly proposed reporting and clinical measures that CMS will track in the calendar year 2014 QIP. Dialysis providers have until Aug. 30 to comment; a final rule will be published sometime in early November.

Clinical Measures (account for 75% of the performance score)

Anemia management

  • (NEW) Patient informed consent for anemia treatment
  • Carried over measures: hemoglobin > 12 g/dL

Adequacy (no new measures)

  • Carried over measures/revised/expanded
  • A Kt/V measure for adult hemodialysis patients; for adult peritoneal dialysis patients; for pediatric hemodialysis patients

Vascular access care (no new measures)

  • Carried over measures: arterial venous (AV) fistula use, catheter use

Bone mineral metabolism management

  • (NEW) Measuring hypercalcemia

Patient safety

  • (NEW) National Healthcare Safety Network (NHSN) bloodstream infection in hemodialysis outpatients

 

Reporting Measures (account for 25% of the performance score)

  • (NEW) Use of iron therapy in pediatric patients
  • (NEW) Gathering data on comorbidities
  • tracking phosphorus results
  • Carried over measures:  anemia management, mineral metabolism, In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS)

“At this time, we are not proposing to adopt measures that address care coordination, efficiency, population and community health, or cost of care," said CMS on future measures. "However, we are soliciting comments in this proposed rule on potential measures that would cover these areas."