WASHINGTON—Piggybacking on the recently released bundle payment final rule, the Centers for Medicare & Medicaid Services (CMS) also issued a proposed rule on July 26 that would establish a new quality incentive program (QIP) that links a clinic’s payments to performance standards.
Under the rule, CMS would reduce payment rates to a dialysis facility by up to 2 percent if that facility fails to meet certain quality measures.
Click HERE to read the proposed rule.
The proposed dialysis quality incentive program is the first pay-for-performance program in a Medicare fee-for-service payment system, according to CMS.
“The new payment system and quality incentive program for dialysis services have significant potential to improve patient outcomes and promote efficient delivery of healthcare services,” said CMS Administrator Donald Berwick, MD. “In addition, for the first time in any of our payment systems, the quality of care facilities furnish to patients will be reflected in their payment rates.”
Currently, facilities only report on whether they have complied with quality measures, according to CMS.
The new bundled payment system and the proposed QIP were required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The law requires the ESRD PPS to pay dialysis facilities a single bundled rate for renal dialysis services and home dialysis, while the proposed QIP promotes quality of service furnished by these facilities by creating payment incentives for them to take steps to improve patient outcomes.
The proposed rule would establish performance standards and a scoring methodology for the Quality Incentive Program. “The ESRD QIP is a critical tool for encouraging and supporting dialysis facilities to focus their energies thoroughly on the quality of the dialysis care they provide to Medicare beneficiaries,” said Berwick.
In the ESRD final payment rule, CMS adopted the three quality measures that will be used in the initial implementation of the QIP. Two of these measures reflect whether patients are receiving appropriate treatment for anemia—that is, whether the amount of iron in the blood is neither too low, nor too high. The third measure captures patients’ urea reduction ratio, which indicates how well dialysis treatments are removing wastes from patients’ bodies.
The law requires CMS to reduce the payment rates to a dialysis facility by up to 2 percent if that facility fails to meet or exceed the established performance scores with regard to performance standards established for each quality measure. Facilities failing to meet or exceed specified total performance scores will receive reduced reimbursement for dialysis services on or after Jan. 1, 2012.
The QIP proposed rule also discusses options for making individual facility performance scores available both to dialysis patients and to the general public as required by the law.
CMS will accept comments on the QIP proposed rule until Sept. 24, and will respond to them in a final rule to be issued later this year.
