The Centers for Medicare & Medicaid Services has reaffirmed its decision made at the end of last year to award a new three-year contract to Quality Insights Renal Network to manage ESRD Network 4, after a challenge from current contractor Renal Network Inc. The agency’s decision gave quality improvement organizations a series of wins during competitive bidding for new contracts approved recently by the agency
CMS awards new ESRD network contracts to all 18 ESRD networks every three years. For 2013, CMS randomly selected nine ESRD networks for competitive review. Of those nine, four received competition between the current independent Network and a Quality imprvement organization; all four were awarded to a QIO. The other five of the competed Networks did not receive competition and remained with the current contractor.
The other nine networks that were not competed remained with their current contractor and will be re-bid in 2016.
CMS had originally awarded the ESRD Network 4 contract to Quality Insights Renal Network in December, but The Renal Network Inc., which also holds the management contract for Networks 9 and 10, contested the decision. CMS gave both bidders an opportunity to re-submit proposals, but ultimately affirmed its decision to give Quality Insights the contract. Network 4 covers the states of Pennsylvania and Delaware.
“We are very proud of the improvements in clinical performance measures that have made Network 4 a leader among networks. Our work in vascular access, patient services, and transitions of care was recognized by CMS as best practice,” wrote Network 4 Executive Director Susie Stark and Project Director Shane Perry, in an April 17 letter to the renal community after losing the bid. “All of these achievements were made possible by the leadership of the Network 4 Medical Review Board and by the extraordinary efforts of each of you. We are proud to have had the privilege of working with you and wish you Godspeed as you continue to improve the health and lives of ESRD patients.”
QIOs contract with CMS to provide quality review and improvement projects for the ESRD Program, but also offer those services to CMS for multiple medical specialties that are covered by Medicare. The Quality Insights Renal Network, based in Cranbury, N.J., already manages Renal Network 3 (the New Jersey Network, which also covers Puerto Rico and the U.S. Virgin Islands). West Virginia Medical Institute manages Network 5, the Mid Atlantic Renal Coalition, which covers Washington, D.C., Maryland, Virginia, and West Virginia.
With the final decision of awarding the Network 4 contract to QIRN, half of the 18 ESRD Networks are now operated by QIOs (Network 8, which covers Tennessee, Mississippi, and Alabama, merged last year with the Georgia Quality Improvement Organization, which is operated by Alliant GMCF). The changes in Network management this year include:
- ESRD Network 1 (New England) was awarded to Island Peer Review Organization, which also received a contract renewal to manage Network 2.
- ESRD Networks 13 (Arkansas, Louisiana, Oklahoma) and 18 (Southern California) were awarded to Florida Medical Quality Assurance Inc., which also received a contract renewal for Network 7 in Florida.
- ESRD Network 4 (Pennsylvania and Delaware) was awarded to Quality Insights Renal Network, which manages Network 3.
The Renal Network Inc. did receive a renewal of its contract for ESRD Network 10, as did the Renal Network of the Upper Midwest for ESRD Network 11 and the Northwest ESRD Network for ESRD Network 16.