ESRD Quality Incentive Program Glossary

Achievement Range

In calculating clinical measure scores, a scale that runs from the achievement threshold to the benchmark.

Achievement Score

Compares the facility’s performance on a clinical measure during the performance period to the performance of all other facilities during a comparison period.

Achievement Threshold

The 15th percentile of performance rates nationally during a comparison period.

Baseline Period

See Comparison Period.

Benchmark

In calculating clinical measure scores, the 90th percentile of performance rates nationally during the comparison period.

Clarification Question

An opportunity during the Preview Period to request information that allows a facility to fully understand how its scores were calculated. This may include requesting patient-level data.

CMS Certification Number (CCN)

A number assigned to a facility for billing and administrative purposes. Each facility has a primary CCN, but may potentially submit claims under alternate CCNs. The CCN is sometimes referred to as the “billing number” or “provider number.”

Comment Period

The 60 days following the publication of a proposed rule, during which the public has the opportunity to respond to elements within the rule.

Comparison Period

Range of time (usually a full year) used to gather data and determine the rates against which a facility’s rates during the performance period are compared for purposes of measure scoring.  The periods may differ for different scoring elements (e.g. achievement and improvement).  

For example, the comparison period for achievement thresholds, benchmarks, improvement thresholds, and performance standards for PY 2014 is July 1, 2010, through June 30, 2011.  For PY 2014, the comparison periods are referred to as the “baseline period.”  For PY 2015, the comparison period for the achievement thresholds, benchmarks, and performance standards is proposed to be CY 2011; the comparison period for the improvement thresholds is proposed to be CY 2012.

Facility

A Medicare-certified Dialysis Center that provides outpatient dialysis treatment for ESRD beneficiaries. Centers may be independent, part of a hospital, or part of a chain.

Formal Inquiry

An opportunity during the Preview Period to provide CMS with a specific explanation or evidence of why the facility believes that an error in the calculation of its scores occurred. A facility may only submit ONE formal inquiry during the Preview Period.

Kt/V                

A measure of dialysis adequacy where K = dialyzer clearance of urea; t = dialysis time; and V = patient’s total body water.

Improvement Range

In calculating clinical measure scores, a scale that runs from the improvement threshold to the benchmark.

Improvement Score

Compares the facility’s performance on a clinical measure during the performance period to its own performance during a comparison period.

Improvement Threshold

The facility’s own performance on a clinical measure during a comparison period.

Measure

The high-level CMS definition of how quality of care is assessed. By law, the ESRD QIP must contain measures for anemia management and dialysis adequacy. CMS determines these and other measures based on available data and leading scientific understanding of quality of care applicable to ESRD patients.

Measure Rate

The raw value of a facility’s performance, expressed as a percentage. This number is used to calculate each clinical measure score. (Also referred to as the Performance Rate.)

Measure Score

The value that a facility earns for its performance on a measure. This score is used to calculate the Total Performance Score. The facility’s clinical activities during the performance period will be measured against that of all facilities (achievement) or its own past performance (improvement), and the better of the two results will serve as the facility’s score for the measure. For reporting measures, the facility earns points by satisfying requirements according to a points system.

MIPPA

Medicare Improvements for Patients and Providers Act of 2008, providing the legislative authority for the ESRD QIP.

Payment Reduction Percentage

A percentage reduction in Medicare payments, resulting from a failure to meet a minimum Total Performance Score, that is applied to dialysis services provided by a facility during the applicable payment year.

Payment Year (PY)

The calendar year in which a facility’s scores are publicly reported and payment reductions (if any) are applied. The performance period for which a facility is evaluated occurs prior to the payment year.

Performance Period

The range of time in which a facility’s performance on clinical and reporting measures is evaluated to determine measure rates and scores.

Performance Rate

See Measure Rate. 

Performance Score Certificate (PSC)

An annual document produced for each facility that summarizes for the general public the facility’s ESRD QIP performance information. The PSC must be posted in a prominent location within the facility for the entirety of a given calendar year. Also referred to as “the certificate.” In the near future, CMS intends to provide a Spanish version of the PSC to accompany the English version.

Performance Score Report (PSR)

An annual document produced for each facility describing the individual measure calculations and the composite calculations making up the facility’s Total Performance Score. A preliminary PSR is released at the beginning of the Preview Period; a final PSR is released after the Preview Period has concluded and all calculations (including the Total Performance Score and payment reductions) have been finalized.

Performance Standard

The rate against which a facility’s individual performance period rate is compared.  The relevant standard(s) are defined in each rulemaking for the applicable PY.

Preview Period

The 30-day timeframe during which facilities may review calculations related to their performance scores and projected payment reduction percentage, and submit questions to CMS about these calculations. 

A facility may submit clarification questions to better understand how its score(s) were calculated, and may also request technical assistance in using the website. A facility may submit a single formal inquiry in the event that the facility believes that an error in calculation has been made.  

Total Performance Score (TPS)

The aggregate, weighted score of all measure scores for a year.  The Total Performance Score is calculated using a weighting system that reflects the facility’s performance on the measures, as well as CMS’s judgment regarding the importance of each measure.

AHRQ

Agency for Healthcare Research and Quality (part of HHS)

CCN

CMS certification number

CCSQ

Center for Clinical Standards and Quality (part of CMS)

CDC

Centers for Disease Control & Prevention

CMS

Centers for Medicare & Medicaid Services

CY

Calendar year

DFC

Dialysis Facility Compare

ESA

Erythropoiesis-stimulating agent (a substance  used to promote the growth of red blood cells; used in the ESRD community to treat patients on dialysis who have anemia)

ESRD QIP

End-Stage Renal Disease Quality Incentive Program

FDA

Food and Drug Administration

g/dL

Grams per deciliter (a unit measure for hemoglobin)

HCPCS

Healthcare Common Procedure Coding System

HHS

(U.S.) Department of Health and Human Services

ICH CAHPS

In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems

MIPPA

Medicare Improvements for Patients and Providers Act of 2008

NHSN

National Healthcare Safety Network (a function of the CDC)

NPRM

Notice of Proposed Rule Making

PSC

Performance score certificate

PSR

Performance score report

PPS

Prospective payment system

PY

Payment year

SSA

Social Security Act

TPS

Total performance score

URR

Urea Reduction Ratio (a measure of dialysis adequacy)

VAT