The ESRD Quality Incentive Program (ESRD QIP)
The Medicare ESRD Program instituted legislatively mandated changes in 2011 for dialysis services. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare’s first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program.
Facilities that do not meet or exceed performance standards will be subject to a payment reduction of up to two percent depending on how far their performance deviates from the standards. These standards and measures will be made public for people to compare facility performance when choosing dialysis centers.
The ESRD QIP payment adjustments will apply to payments for outpatient maintenance dialysis items and services furnished to Medicare beneficiaries by ESRD.
The Network’s Role
The Network is charged with supporting the ESRD QIP, educating Patient/Family/Care Partners and facility staff about Dialysis Facility Compare, the ESRD QIP, and supporting Patients/Family/Care Partners as engaged consumers.
The Network is charged to collaborate with the State Survey Agency (SSA) to ensure dialysis facility compliance with annually posting the current performance score certificate (PSC).
For detailed information on the ESRD QIP, performance and reporting measures by year and methodology, please go to Medicare’s ESRD Quality Incentive page.
ESRD QIP Program Process
- Summer: CMS publishes a Proposed Rule via Notice of Proposed Rulemaking (NPRM) in the Federal Register
- Public has a 60-day period to comment
- Fall: CMS takes public comment into consideration and publishes a Final Rule in the Federal Register
Performance Score Certificate (PSC): The first PSCs were issued to Dialysis Providers in December, 2011. The PSC is updated annually, and Providers must post the signed PSC in a public area of their facility.