ESRD Quality Incentive Program - Monitoring & Evaluation
Guidance for explaining to Medicare providers how CMS monitors and evaluates under the ESRD Quality Incentive Program.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 07, 2016
CMS is committed to examining and analyzing ESRD QIP impacts to identify untoward and unintended consequences, along with best practices at the facility level that enhance and support ongoing Quality Improvement (QI) initiatives across all ESRD Renal Networks.
CMS implemented provisions for strengthening the ESRD Quality Incentive Program in the CY 2012 Final Rule, which reduces payment to dialysis facilities if the facility does not achieve a high enough total performance score based on their performance on measures that assess the quality of dialysis care. Both the ESRD Prospective Payment System (PPS) and the Quality Improvement Program were mandated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
Monitoring
CMS monitors quality of and access to care for beneficiaries with ESRD. The monitoring program serves as an early-detection system to identify potential changes in ESRD service delivery, and alerts CMS of a need for further investigation or appropriate action. Findings from the monitoring program help develop long-term evaluation studies to determine the cause(s) of observed changes and to drive continuous improvement.
Evaluation
CMS’s evaluation program seeks to measure changes in outcomes with a higher degree of certainty, assessing the strength and weakness of the relationship between program policies and outcomes. Evaluation usually requires more data to be collected over a longer period of time than is necessary to conduct monitoring activities. Evaluation studies seek to increase patient protections, improve program design, inform measures development, and improve the overall Medicare ESRD program. The evaluation program also seeks to identify “best practices” that could be adopted by other ESRD facilities.
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