This page features a listing of the words and acronyms most commonly used to describe the End-stage Renal Disease (ESRD) Quality Incentive Program (ESRD) QIP.
If you have a question that is not answered by this website, please contact us at ESRDQIP@cms.hhs.gov.
In calculating clinical measure scores, a scale that runs from the achievement threshold to the benchmark.
Compares the facility’s performance on a clinical measure during the performance period to the performance of all other facilities during a comparison period.
The 15th percentile of performance rates nationally during a comparison period.
See Comparison Period.
In calculating clinical measure scores, the 90th percentile of performance rates nationally during the comparison period.
An opportunity during the Preview Period to request information that allows a facility to fully understand how its scores were calculated. This may include requesting patient-level data.
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.”
The 60 days following the publication of a proposed rule, during which the public has the opportunity to respond to elements within the rule.
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 may differ for different scoring elements (e.g. achievement and improvement).
For example, the comparison period for achievement thresholds, benchmarks, improvement thresholds, and performance standards for PY 2014 is July 1, 2010, through June 30, 2011. For PY 2014, the comparison periods are referred to as the “baseline period.” For PY 2015, the comparison period for the achievement thresholds, benchmarks, and performance standards is proposed to be CY 2011; the comparison period for the improvement thresholds is proposed to be CY 2012.
A Medicare-certified Dialysis Center that provides outpatient dialysis treatment for ESRD beneficiaries. Centers may be independent, part of a hospital, or part of a chain.
An opportunity during the Preview Period to provide CMS with a specific explanation or evidence of why the facility believes that an error in the calculation of its scores occurred. A facility may only submit ONE formal inquiry during the Preview Period.
A measure of dialysis adequacy where K = dialyzer clearance of urea; t = dialysis time; and V = patient’s total body water.
In calculating clinical measure scores, a scale that runs from the improvement threshold to the benchmark.
Compares the facility’s performance on a clinical measure during the performance period to its own performance during a comparison period.
The facility’s own performance on a clinical measure during a comparison period.
The high-level CMS definition of how quality of care is assessed. By law, the ESRD QIP must contain measures for anemia management and dialysis adequacy. CMS determines these and other measures based on available data and leading scientific understanding of quality of care applicable to ESRD patients.
The raw value of a facility’s performance, expressed as a percentage. This number is used to calculate each clinical measure score. (Also referred to as the Performance Rate.)
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 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.
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 a facility during the applicable payment year.
Payment Year (PY)
The calendar year in which a facility’s scores are publicly reported and payment reductions (if any) are applied. The performance period for which a facility is evaluated occurs prior to the payment year.
The range of time in which a facility’s performance on clinical and reporting measures is evaluated to determine measure rates and scores.
See Measure Rate.
Performance Score Certificate (PSC)
An annual document produced 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.” In the near future, CMS intends to provide a Spanish version of the PSC to accompany the English version.
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.
The rate against which a facility’s individual performance period rate is compared. The relevant standard(s) are defined in each rulemaking for the applicable PY.
The 30-day timeframe during which 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 clarification questions to better understand how its score(s) were calculated, and may also request technical assistance in using the website. A facility may submit a single formal inquiry in the event that the facility believes that an error in calculation has been made.
Total Performance Score (TPS)
The aggregate, weighted score of all measure scores for a year. 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
Agency for Healthcare Research and Quality (part of HHS)
CMS certification number
Center for Clinical Standards and Quality (part of CMS)
Centers for Disease Control & Prevention
Centers for Medicare & Medicaid Services
Dialysis Facility Compare
Erythropoiesis-stimulating agent (a substance used to promote the growth of red blood cells; used in the ESRD community to treat patients on dialysis who have anemia)
End-Stage Renal Disease Quality Incentive Program
Food and Drug Administration
Grams per deciliter (a unit measure for hemoglobin)
Healthcare Common Procedure Coding System
(U.S.) Department of Health and Human Services
In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems
Medicare Improvements for Patients and Providers Act of 2008
National Healthcare Safety Network (a function of the CDC)
Notice of Proposed Rule Making
Performance score certificate
Performance score report
Prospective payment system
Social Security Act
Total performance score
Urea Reduction Ratio (a measure of dialysis adequacy)
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