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Clinical Performance Measures (CPM) Project

Section 4558 (b) of the Balanced Budget Act (BBA) requires CMS to develop and implement by January 1, 2000, a method to measure and report the quality of renal dialysis services provided under the Medicare program. To implement this legislation, CMS decided to fund the development of CPMs based on the National Kidney Foundation's Dialysis Outcome Quality Initiative (DOQI) Clinical Practice Guidelines.

Phase I: 

On April 1, 1998, CMS awarded a contract to Qualis Health a private, non-profit health care quality improvement organization to develop a set of ESRD CPMs based on the DOQI Guidelines. Phase I of the project (April 1, 1998 - January 31, 1999) involved the prioritization of the DOQI Guidelines as to their feasibility of being converted into CPMs, the development of algorithms for the applications of the CPMs, and the development of proposed data collection instruments, data specifications and methodology for the collection of the CPMs. 

Sixteen ESRD CPMs (five for hemodialysis (HD) adequacy, three for peritoneal dialysis (PD) adequacy, four for anemia management and four for vascular access) were developed.

Phase II

This phase, dating from February 1, 1999 - March 1, 2000, involved the pilot testing of the CPMs developed in Phase I (testing for reliability and validity). Under CMS' direction, PRO-West conducted the pilot testing of the CPMs. The pilot testing methodology was the same as that used for the ESRD Core Indicators Project (random national sample of adult HD patients, stratified by Network area, and a random national sample of adult PD patients). The pilot testing was completed in September 1999. Reports describing the results of the 1999 CPM data collection are listed below. On March 1, 1999, the ESRD Core Indicators Project was merged with the ESRD CPMs Project and the project is now known as the ESRD CPMs Project. The ESRD CPMs are similar to the core indicators with the addition of measures for vascular access. The ESRD CPMs are collected annually on a national random sample of adult hemodialysis and peritoneal dialysis patients. 

Phase III

To continue ESRD Quality Improvement efforts, CMS has adopted effective April 1, 2008, 26 CPMs in order to further monitor the quality of care being delivered to ESRD patients.

The CPMs were developed by experts in the ESRD community and based on the Kidney Disease Outcomes Quality Initiative (KDOQI). Recommendations that were compiled by the ESRD experts for the CPMs can be viewed in the document labeled "ESRD TEP Final Report 05212008." Information about KDOQI is available on the National Kidney Foundations website, www.kidney.org/professionals/KDOQI/.

Phase IV

In March 2010, six Clinical Technical Expert Panels (C-TEPs) were convened in a two-day meeting to provide expertise and input to CMS and its contractors, Arbor Research Collaborative for Health and the University of Michigan Kidney Epidemiology and Cost Center, on the development and implementation of quality measures that will be used to assess and improve the quality of care for Americans with End-Stage Renal Disease. The C-TEPs provided guidance in the development of new quality measures in specific clinical areas (Fluid Weight Management, Anemia Management Iron Stores, Mineral Metabolism, Vascular Access Infections, Pediatric Adequacy of Hemodialysis, and Pediatric Anemia Management), as well as in defining target values for specific current measures.