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Measuring Quality

CMS makes rules that specify the measures, scoring methodologies, and payment-reduction ranges applicable to that PY.  MIPPA Section 153(c) requires CMS to use certain types of quality measures as part of the ESRD QIP each year. These include:

  • Measures on anemia management that reflect the labeling approved by the Food and Drug Administration (FDA) for administration of erythropoiesis-stimulating agents (ESAs)
  • Measures on hemodialysis adequacy
  • Other measures the Secretary of HHS specifies

CMS ESRD Measures Manual

The CMS ESRD Measures Manual (Manual) contains the detailed specifications that underwrite clinical performance measures in the ESRD QIP and Dialysis Facility Compare (DFC). CMS recognizes that seemingly minor and esoteric aspects of the measure specifications may have a substantial impact on measure scores. Accordingly, the Manual provides a transparent and detailed description of how CMS ESRD measures are calculated, offering the public a comprehensive understanding of how CMS evaluates the quality of care provided by dialysis facilities.

In 2016, CMS issued the initial edition of the Manual that, in part, addressed PY 2018 measures of the ESRD QIP.

On June 28, 2016, CMS held a webinar describing the Manual. Here are the slides and transcript from that session.

In May 2017, CMS issued an updated edition of the Manual that, in part, addressed PY 2019 measures of the ESRD QIP.

In October 2017, CMS released a revised edition of that Manual that addressed PY 2019 ESRD QIP measures and the DFC measures captured in its October 2017 release. As part of that issuance, CMS released a set of resources for associated International Statistical Classification of Diseases and Related Health Problems (ICD) codes