ESRD Quality Incentive Program
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 Care Compare on the Medicare.gov website. In addition, each facility is required to display a Performance Score Certificate (PSC) that lists its Total Performance Score (TPS), as well as its performance on each of the quality measures identified for that 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 . The maximum payment reduction CMS can apply to any facility is two percent. This reduction applies to all 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.
The latest ESRD QIP update
Performance Score Reports for PY 2024 were provided to each renal dialysis facility on November 13, 2023. The PSR gives facilities their measure rates, Total Performance Score (TPS), and total payment reduction for PY 2024.
CMS will publicly report the facility scores from PY 2024 Provider Data Catalog in April 2024.
On November 6, 2023, CMS published the Calendar Year (CY) 2024 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule which contains ESRD QIP policies covering PYs 2026 - PY 2027. See the page for more information regarding the ESRD QIP rules.
For more information regarding the ESRD QIP Program, refer to the ESRD QIP page located at QualityNet.cms.govand the frequently asked questions available in the ESRD QIP tool. Additional questions can be submitted in the Q&A tool by selecting ‘Ask a Question’.