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ESRD QIP Glossary of Terms

Glossary

 

Term

Definition

Achievement Range

A scale, running between the facility’s achievement threshold
and the benchmark, that is used to calculate the facility’s achievement score.

Achievement Score

Compares the facility’s performance during the performance period to the performance of all other facilities during a comparison period.

Achievement Threshold

The 15th percentile of performance rates nationally during a comparison period. Used to calculate clinical measure scores.

Benchmark

The 90th percentile of performance rates nationally during a comparison period. Used to calculate clinical measure scores.

Clarification Question

An opportunity to request information that allows a facility to fully understand how its scores were calculated.

Clinical Measure

A measure that scores facilities based on the quality of services provided to patients with ESRD with regard to anemia management, dialysis adequacy, vascular access, infections, and hypercalcemia. Generally, clinical measures are scored based on facility achievement and improvement alike.

CMS Certification Number (CCN)

A number assigned to a facility for billing and administrative purposes. Each facility has a primary CCN, but may potentially submit claims under alternate CCNs. The CCN is sometimes referred to as the “billing number” or “provider number.”

Comparison Period

Range of time (usually a full year) used to gather data and determine the rates against which a facility’s rates during the performance period are compared for purposes of measure scoring. The periods will differ for different scoring elements (e.g., achievement and improvement). For example, in PY 2015, the comparison period for the achievement thresholds, benchmarks, and performance standards is CY 2011; the comparison period for the improvement thresholds is CY 2012.

Facility

Medicare-certified entity that provides outpatient dialysis for beneficiaries with ESRD. Facilities may be independent, part of a hospital, or part of a chain.

Formal Inquiry

An opportunity to provide CMS with a specific explanation or evidence of why you believe there was an error with your score. A facility may only submit one formal inquiry during the Preview Period.

Kt/V

A measure of dialysis adequacy where K = dialyzer clearance of urea; t = dialysis time; and V = patient’s total body water. The measure also is known as “single pool” Kt/V (spKt/V), as it assumes that excess water and urea are removed from only one body compartment, and does not reflect rebound of water and waste products contributed by other body compartments.

Improvement Range

A scale, running between the facility’s improvement threshold and the benchmark, that is used to calculate the facility’s improvement score.

Improvement Score

Compares the facility’s performance on a clinical measure during the performance period to its own performance during a comparison period.

Improvement Threshold

The individual facility’s performance during a comparison period.

Measure

The high-level CMS definition of how quality of care is assessed.

Measure Score

The value that a facility earns for its performance on a measure. This score is used to calculate the Total Performance Score. The facility’s clinical activities during the performance period generally will be measured against that of all facilities (achievement) or its own past performance (improvement), and the better of the two results will serve as the facility’s score for the measure. For reporting measures, the facility earns points by satisfying requirements according to a points system.

MIPPA

Medicare Improvements for Patients and Providers Act of 2008, providing the legislative authority for the ESRD QIP.

Payment Reduction Percentage

A percentage reduction in Medicare payments, resulting from a failure to meet a minimum Total Performance Score, that is applied to dialysis services provided by that facility during the applicable payment year. Payment reductions range from 0.5% to 2%.

Payment Year (PY)

The calendar year in which a facility’s scores are publicly reported and payment reductions are applied. The performance period for which a facility is assessed occurs prior to the payment year.

Performance Period

The range of time in which a facility’s performance on clinical and reporting measures is evaluated to determine performance rates and scores.

Performance Rate

The raw value of a facility’s performance, expressed as a percentage. This number is used to calculate each clinical measure score.

Performance Score Certificate (PSC)

An annual document produced in English and Spanish for each facility that summarizes for the general public the facility’s ESRD QIP performance information. The PSC must be posted in a prominent location within the facility for the entirety of a given calendar year. Also referred to as “the certificate.”

Performance Score Report (PSR)

An annual document produced for each facility describing the individual measure calculations and the composite calculations making up the facility’s Total Performance Score. A preliminary PSR is released at the beginning of the Preview Period; a final PSR is released after the Preview Period has concluded and all calculations (including the Total Performance Score and payment reductions) have been finalized.

Performance Standard

The rate against which a facility’s individual performance period rate is compared. These standards are defined in rulemaking for the applicable PY.

Preview Period

The 30-day period when facilities may review calculations related to their performance scores and projected payment reduction percentage and submit questions to CMS about these calculations. A facility may submit one formal inquiry to address concerns about its score(s), as well as clarification questions to better understand how its score(s) were calculated.

Reporting Measure

A measure that scores facilities based on whether they provided particular data during the performance period. Reporting measures in the ESRD QIP are designed to provide data upon which the program can establish future clinical measures, including the calculation of performance standards, benchmarks, and achievement thresholds.

Small-Facility Adjuster

An adjustment to the clinical performance rates and improvement thresholds for facilities that treat 11 – 25 eligible patients for a given clinical measure. The small sample size in these facilities puts them at risk for having one or two challenging patients dramatically alter their performance rates and ESRD QIP performance scores. The ESRD QIP therefore applies a favorable adjustment to performance rates for facilities with 11 – 25 cases. The adjustment can only improve a measure score; it will never penalize a facility. The small-facility adjustment is made for each individual clinical measure.

spKt/V

See Kt/V.

Total Performance Score (TPS)

The aggregate, weighted score of all measure scores.  The Total Performance Score is calculated using a weighting system that reflects the facility’s performance on the measures as well as CMS’s judgment regarding the importance of each measure.

 

Table of Acronyms

 

Acronym

Definition

AHRQ

Agency for Healthcare Research and Quality

CCN

CMS Certification Number

CCSQ

Center for Clinical Standards and Quality
(a part of CMS)

CDC

Centers for Disease Control & Prevention

CMS

Centers for Medicare & Medicaid Services

CY

calendar year

DFC

Dialysis Facility Compare

ESA

erythropoiesis-stimulating agent

ESRD QIP

End-Stage Renal Disease Quality Incentive Program

FDA

Food and Drug Administration

g/dL

grams per deciliter (a unit measure for hemoglobin)

HCPCS

Healthcare Common Procedure Coding System

HHS

Department of Health & Human Services

ICH CAHPS

In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems

MIPPA

Medicare Improvements for Patients and Providers Act of 2008

NHSN

National Healthcare Safety Network (a function of the CDC)

NPRM

Notice of Proposed Rule Making

PSC

Performance Score Certificate

PSR

Performance Score Report

PPS

Prospective Payment System

PY

payment year

SSA

Social Security Act

TPS

Total Performance Score

URR

Urea Reduction Ratio (a measure of dialysis adequacy)

VAT

Vascular Access Type

.