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Abstract: TH-PO286

The Centers for Medicare & Medicaid Services ESRD Quality Incentive Program (QIP): Measurement, Monitoring, and Evaluation

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Pearson, Jeffrey, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Esposito, Dominick, Insight Policy Research, Arlington, Virginia, United States
  • Adeleye, Adebola O., Centers for Medicare and Medicaid Services, Woodlawn, Maryland, United States
  • Houseal, Delia, Centers for Medicare and Medicaid Services, Woodlawn, Maryland, United States
  • Turenne, Marc, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Kapke, Alissa, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Tucker, Meg G., Insight Policy Research, Arlington, Virginia, United States
  • Schott, Whitney B., Insight Policy Research, Arlington, Virginia, United States
  • Chen, Josh, Insight Policy Research, Arlington, Virginia, United States
  • Szymanski, Amanda, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Young, Eric W., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Leichtman, Alan B., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Mandated in 2008, QIP is Medicare’s premier value-based purchasing program. Congress designed QIP to link dialysis facility quality with payment. Initially QIP used measures of anemia and hemodialysis adequacy; it now includes a broad set of clinical, safety, and reporting measures. With the recent Meaningful Measures Initiative, CMS is interested in a measure set that reflects the highest priorities for quality measurement and improvement. We describe ongoing monitoring of QIP measures and evaluation of QIP influence on quality, overall and among subgroups of patients and facilities.

Methods

We used Medicare claims, CROWNWeb, and other CMS data to monitor monthly trends in QIP measures during 2010-17.

Results

Performance has improved over time under the QIP for most quality indicators, and has remained relatively stable for the remainder (figure). Smaller recent changes for some indicators may reflect diminishing opportunities for improvement where performance levels are already relatively high (e.g. hemodialysis adequacy, hypercalcemia). Performance was lower for some patient subgroups (e.g. black race, young adults) for some indicators (e.g. fistula use, readmissions, emergency department visits). Many indicators varied by facility characteristics, including ownership, hospital-based vs freestanding, and size. For example, facilities not affiliated with large chains often had consistently lower performance (e.g. peritoneal dialysis adequacy, hospitalizations) or took longer to achieve similar performance levels (e.g. hemodialysis adequacy, fistula use).

Conclusion

In the era of the QIP, overall performance has improved on many indicators of quality of care. Variation in performance on some indicators based on patient and facility characteristics suggests continued opportunities for improvement.

National Trends in QIP Measures, 2010-17

Funding

  • Other U.S. Government Support