ESRD Quality Incentive Program

What is the ESRD QIP?

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 the Care Compare tool on Medicare.gov. In addition, each facility is required to display a Performance Score Certificate (PSC) that lists its Total Performance Score (TPS), for that payment 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 measures. The maximum payment reduction CMS can apply to any facility is two percent. This reduction applies to all traditional Medicare 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.

Annual ESRD QIP updates

Preview and Final Performance Score Reports (PSRs) are made available for each dialysis facility to download from EQRS in July and December of each year. The PSR gives facilities their measure rates, TPS, and total payment reduction for the payment year. See the Resources page on EQRS.CMS.gov for more information. CMS will publicly report the facility scores in the Provider Data Catalog in January of each payment year.

CMS publishes updates to the ESRD QIP in the ESRD Prospective Payment System (PPS) Final Rule in the fall of each year. See the Laws & Regulations page for more information regarding the ESRD QIP rules.

More information

For more information regarding the ESRD QIP Program, refer to the ESRD QIP page located at QualityNet.cms.gov and the frequently asked questions available in the ESRD QIP Question and Answer (Q&A) tool. Additional questions can be submitted in the Q&A tool by selecting ‘Ask a Question’.