Abstract: FR-PO1054
Ballooning Complexity of Dialysis Quality Measures over a Quarter Century
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Vidhun, Tanya, Harvard University, Cambridge, Massachusetts, United States
- Trivedi, Amal, Brown University, Providence, Rhode Island, United States
- Lin, Eugene, Keck Medicine of USC, Los Angeles, California, United States
Background
Medicare assesses dialysis quality using the Quality Incentive Program (QIP), which financially penalizes poor performance, and Dialysis Facility Compare (DFC), which assigns each facility a publicly available 5-star rating. Despite the consequences of these programs on reimbursement and public reporting, little is known about the overlap, stability, and consistency of the programs.
Methods
From Medicare’s promulgated rules and measure specifications, we mapped the dialysis quality measure landscape and changes over time from 2001-2026. We categorized measures by beneficiary inclusion, risk adjustment model, program inclusion in the QIP, DFC or both, and assessed measure alignment across both programs. We assessed annual changes to measures, including additions, removals, and modifications.
Results
DFC grew from 3 measures in 2001 to 19 measures in 2026. QIP similarly expanded from 3 measures in 2010 to 15 measures in 2026 (Figure 1). Measure alignment between the two programs shrank over time. By 2026, less than 50% of measures (11 out of 23) overlapped between the two programs, and 3 of those 11 (27%) had conflicting specifications. QIP measures saw little stability year-to-year (Figure 2). In only 3 of the last 11 years was the QIP identical to the previous year. There was only year (2024) where >75% of measures were stable for at least 4 years.
Conclusion
There is substantial year-to-year heterogeneity in dialysis quality measures with little alignment across programs. Policymakers should consider harmonizing and maintaining stability in measures to increase their relative effectiveness in driving quality improvement.
The Dialysis Quality Measure Landscape
Changes to QIP Program
Funding
- NIDDK Support