7 Things You Should Know About ESRD QIP 2019
- The Centers for Medicare & Medicaid Services (CMS) manages the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) to promote high-quality services in outpatient dialysis facilities. A portion of Medicare payments are directly linked to facilities’ performance on quality of care measures determined by CMS. When a facility’s overall score on applicable measures does not meet established standards, Medicare payment is reduced by 0.5% to 2%, based on the score. To receive a QIP score the facility must treat at least 11 eligible patients and be certified by CMS before June 30 2017.
Here are 7 facts you must know about ESRD QIP Score
- QIP program continues to evolve through the years and common change you notice each year is the number and type of measures used to build the score. For the Payment Year (PY) 2019, a total of 14 measures (8 clinical and 6 reporting) are used to assess the quality of ESRD care.
- The QIP score is associated with 3 time periods:
- Payment year – is the current year (2019)
- The comparison period – is when a full year of data for all facilities in the country analyzed. This data serves as a basis to evaluate the facility’s performance during the ‘Performance period’
- Performance period – is the year that follows comparison year and 2 years prior to Payment year. For 2019 Payment year, the performance period is 2017
- 75% of your score is derived from “clinical” measures such as hospital readmissions, ICH CAHPS, vascular management, infection management and dialysis adequacy. It is expected that the facility performs better or the same from previous year on these measures.
- 10% of the score is derived from “reporting” measures such as mineral metabolism, anemia management, pain assessment, depression screening and staff influenza vaccination. These measures require that the facility only have to report the data to score full points, regardless of performance.
- “Safety” measure domain is introduced in 2019 that contain one clinical measure (NHSN infection rate) and one reporting measure (adverse events rate). This domain captures 15% of the QIP score.
- Data to assess performance on the clinical measures is drawn from Medicare claims, CROWNWeb, and other CMS and federal databases. Therefore, it is important that you report accurately on CROWNWeb and NHSN.
- For year 2019 PY, a facility needs to score a minimum of 59 points to avoid any payment reduction.
If you need assistance to improve your QIP score or to educate your staff, please contact us below.