ESRD Quality Incentive Program
The Centers for Medicare & Medicaid Services (CMS) administers the End-Stage Renal Disease Quality Incentive Program (ESRD QIP) to promote high-quality services in renal dialysis facilities. The first of its kind in Medicare, this program changes the way CMS pays for the treatment of patients who receive dialysis by linking a portion of payment directly to facilities’ performance on quality of care measures. These types of programs are known as “pay-for-performance” or “value-based purchasing” (VBP) programs.
CMS publicly reports facility ESRD QIP scores and payment adjustments on Care Compare on the Medicare.gov website. In addition, each facility is required to display a Performance Score Certificate (PSC) that lists its Total Performance Score (TPS), as well as its performance on each of the quality measures identified for that year.
How does the ESRD QIP work?
The ESRD QIP reduces payments to renal dialysis facilities that do not meet or exceed certain performance standards on applicable . The maximum payment reduction CMS can apply to any facility is two percent. This reduction applies to all payments for services performed by the facility receiving the reduction during the applicable payment year (PY).
The ESRD QIP scores facilities on their performance according to the measures established for the relevant payment year. For clinical measures, CMS applies two scoring methods: achievement (comparing facility performance to a set of values derived from all facilities nationally) and improvement (comparing facility performance to the facility's individual performance during the prior year). For reporting measures, CMS assigns points based on whether a facility provided the required data.
Refer to the ESRD QIP Program Details and Payment Year Summary guides in the "Downloads" section for more information regarding the measures, scoring methodology, and payment reduction scales used in each PY.
The latest ESRD QIP update
Performance Score Reports for PY 2022 were provided to each renal dialysis facility on November 18, 2021, followed by a 30-day preview period. The Performance Score Report gives facilities their projected measure rates and Total Performance Score (TPS) prior to any payment reduction for the PY*.
On November 8, 2021, CMS released the Calendar Year (CY) 2021 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule which contains ESRD QIP policies covering PYs 2022 - PY 2025. See the page for more information regarding the ESRD QIP rules.
*For PY 2022, facilities received an “N/A” due to no payment reductions applied for PY 2022. Please refer to the CY 2022 ESRD PPS final rule for additional information related to operational system issues and the effects of the Public Health Emergency on the ESRD QIP.
For more information regarding the ESRD QIP Program, refer to the ESRD QIP page located at QualityNet.cms.govand the frequently asked questions available in the ESRD QIP tool. Additional questions can be submitted in the Q&A tool by selecting ‘Ask a Question’.