Part 2: Proposed Reporting Measures for ESRD QIP PY 2015

On Thursday, July 19, the Centers for Medicare & Medicaid Services (CMS), Office of Clinical Standards and Quality (OCSQ), hosted an open door forum on end-stage renal disease (ESRD) Quality Incentive Program (QIP). The forum focused on proposed rule for operationalizing the ESRD QIP in payment year (PY) 2015.

The public has 60-days to submit any comments about the proposed rule.  All dialysis facilities and ESRD stakeholders are encouraged to review the proposed rule carefully and comment. The comment period will end on August 31. Based on the comments, a final rule will be published in November.

The Proposed Reporting Measures has  four reporting measures for PY 2015. The performance period for PY 2015 is calendar year (CY) 2013.

Patient's experience of care survey administration via In-Center Hemodialysis (ICH)Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey will carry over from PY 2014. It is still required to attest through CROWNWeb to receive the full 10 points.

The National Healthcare Safety Network (NHSN) and the monthly mineral metabolism monitoring will expand from PY 2014 from attestation to provision of data.

 Facilities must enroll and train on the NHSN system. On a monthly basis facilities must report information about dialysis events to NHSN every month with a one-month grace period. For example June data would have to be reported to NHSN by July 31. Ten points will be achieved if your facility reports for 12 months and five points will be given if the data is reported in a minimum of six consecutive months. This is only geared towards facilities that have in-center patients.

For the calculation of mineral metabolism, serum calcium and serum phosphorus, levels must be reported to CROWNWeb on a monthly basis. The one-month grace period applies as well and the same point systems apply. If a patient is at a hospital or on vacation for example, coordination of care is recommended to get the proper values while the patient visits a temporary facility.

The Anemia Management measure is the new proposed measure for PY 2015.  This applies to hemodialysis, PD and pediatric dialysis patients. Facilities for PD patient claims must record ESA dosage as well as hemoglobin or hematocrit values. Twelve months of data, on each individual Medicare patient,  will be necessary in order to earn the maximum 10 points. Half the points will be given if a facility reports a minimum of six consecutive months for all their Medicare patients.

For clinical measures, new facilities are scored as every other facility is scored. It all depends on the number of cases for each measure. For reporting measures, CMS determines how to score depending on when the facility received their CMS Certification Number (CCN). If a facility received the CCN after June 30, 2013 will not be scored on the reporting measures and will not receive a performance score for PY 2015. The reporting period began on the first day of the month after your facility received the CCN. So if you received it March 15, your reporting period would begin April 1.  

For more information on scoring, additional proposals  and examples, log onto the CMS website and see the slideshow.