• CMS issues final rule for dialysis facility quality incentive program

    The Centers for Medicare & Medicaid Services issued a final rule for the Quality Incentive Programthat will establish performance standards for dialysis facilities and provide payment adjustments to individual End-Stage Renal Disease facilities based on how well they meet these standards.

    NNI, December 29, 2010: The final rule establishes the ESRD QIP performance standards, sets out the scoring methodology CMS will use to rate providers quality of dialysis care, and establishes a sliding scale for payment adjustments based on the facilitys performance.  CMS will assess each dialysis facility on how well its performance meets the standard for each measure and will calculate each facilitys Total Performance Score. The maximum Total Performance Score a facility can achieve is 30 (10 points per measure).  Facilities that do not meet or exceed performance standards will be subject to a payment reduction of up to 2% depending on how far their performance deviates from the standards.

    CMS finalized three measures as the initial measure set during the first program year.  Two of these measures are designed to assess whether patients hemoglobin levels are maintained in an acceptable range, while the third measures the effectiveness of the dialysis treatment in removing waste products from patients blood.

    In future years CMS may add quality measures and establish additional performance standards that facilities will need to meet to receive full payment for the services they furnish to Medicare beneficiaries.

    CMS will give providers and facilities the opportunity to review their scores and any resulting payment adjustments prior releasing the ESRD QIP scores and payment reductions publicly. The ESRD QIP payment adjustments will apply to payments under the ESRD PPS for outpatient maintenance dialysis items and services furnished to Medicare beneficiaries by ESRD facilities between Jan. 1, 2012 and Dec. 31, 2012..

    After ESRD facility scores and payment determinations are finalized, CMS will furnish each facility with a PY 2012 certificate noting the facilitys Total Performance Score as well as its score on each individual measure.  Each facility is required to post its certificate in a prominent location in a patient care area for the duration of the payment year.  CMS will furnish each facility with a new certificate annually. CMS will post on the Internet each facilitys total performance score, as well as the scores that facilities earned on the individual measures.

    The final rule was placed on display at the Federal Register today, and can be found under Special Filings at: www.ofr.gov/inspection.aspx#special.