Monitoring & Evaluation

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 an expanded bundled payment system in 2011 eliminating a number of separately billable drugs and services for dialysis facilities. Concerned that the new system might encourage facilities to avoid the sickest and most complicated patients, CMS undertook an ESRD QIP monitoring and evaluation (M&E) effort framed around the three broad aims of the National Quality Strategy. This M&E effort currently focuses on better care in terms of anemia management and access to care. M&E efforts will evolve in time to become more comprehensive in order to more accurately assess the impact of the ESRD QIP on beneficiaries.


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.


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.

ESRD Fact Sheets 

CMS created fact sheets that explain several elements of care important to patients on dialysis, and which are measured within the ESRD QIP. Please read the documents in the Downloads section in the bottom of this page to learn more about how focusing on ESRD QIP topics can improve care for patients on hemodialysis or peritoneal dialysis.

Page Last Modified:
12/07/2016 12:06 PM