Is the CMS Rule for the ESRD Quality Incentive Program Adequate?

From Medscape Nephrology > Berns on Nephrology
Is the CMS Rule for the ESRD Quality Incentive Program Adequate?
Jeffrey S. Berns, MD
Authors and Disclosures
Posted: 02/01/2011

Hello. This is Jeffrey Berns from the University of Pennsylvania School of Medicine in Philadelphia. I am Editor-in-Chief of Medscape Nephrology.

As many of you may know, the Centers for Medicare & Medicaid Services recently released their final rule for the Quality Incentive Program (QIP) for end-stage renal disease (ESRD) patients in the United States.[1] There are only 3 parameters included in the final rule, and these are the percentage of patients with hemoglobin below 10 g/dL, the percentage of patients with hemoglobin above 12 g/dL, and the percentage of patients with a urea reduction ratio of at least 65%.

Whereas these strike me as being very reasonable metrics, I must ask whether this is adequate and sufficient in the future as we move towards a bundled environment for the care of dialysis patients.

I was at a very interesting meeting last week in Washington, DC, as a member of the National Quality for ESRD Steering Committee. We considered a wide variety of metrics spanning the scope of care of ESRD patients. On the panel were a number of patients who presented very interesting and impassioned perspectives on dialysis care in the United States and how we assess and ensure its quality. I'm pretty certain that the patients would not find these 3 metrics adequate, and I'm not sure that I would disagree with them.

It is hard (I learned after that meeting) to come up with evidence-based and meaningful quality metrics that can be applied across a wide spectrum of dialysis facilities and patients in this country and not have unintended consequences that might adversely and unfairly affect either patients or dialysis facilities. Nonetheless, it's hard to believe that we can't come up with some metrics at some point in time that address other aspects of care in dialysis patients (blood pressure, hypertension, hypotension, mineral and bone disease, transplantation referral, dialysis, access, use of home dialysis). We can come up with a whole list of issues at which we might want to look in the future as the QIP matures to better ensure that patients are getting the highest quality care they possibly can.

The National Quality Assurance Program will be endorsing additional measures, and it will be interesting to see how those influence future rollouts of the QIP. I'm sure we will be hearing from patients and others about the need to provide metrics of quality of care for dialysis patients in this country. I would be interested to hear your thoughts about the QIP and other potential quality metrics for dialysis in the United States and submit those through the Medscape video blog site if you care to.

I thank you for your attention. This is Jeffrey Berns from the University of Pennsylvania School of Medicine and Editor-in-Chief of Medscape Nephrology.

http://www.medscape.com/viewarticle/736280