Beginning Jan. 1, 2016, the Centers for Medicare and Medicaid Services will update the formula it uses to pay outpatient dialysis facilities for performance. The End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) promotes high-quality services by linking a portion of payment directly to the dialysis facility's performance on quality-of-care measures.

Interest in improving quality among this population comes as study results in the Journal of the American Society of Nephrology report that 21.7 percent of U.S. dialysis patients die every year, compared to 6.6 percent in Japan and 15.6 percent in Europe. This is 7.4 times higher than the general population, and the U.S. rate is the worst in the world.

Researcher recommendations included funding therapies and practice patterns that attenuate the differences between countries and within populations in the same country. Medicare's ESRD QIP is certainly a step in the right direction.

The ESRD QIP will reduce payments to ESRD facilities, up to 2 percent for all payments during the payment year that do not meet or exceed certain performance standards. Five of the eight clinical measures are organized into two "measure topics" — one evaluates the success of dialysis treatment in removing waste products from patients' blood, and the other examines the type of vascular access used to treat patients.

The remaining three measures evaluate anemia management, addressing hemoglobin levels; infections incurred by in-center hemodialysis outpatients; and hypercalcemia, a measure of mineral metabolism. As the program and clinical understanding evolves, it will include quality of life and additional clinical measures.

Facilities will be required to:

  1. Report hemoglobin or hematocrit values and ESA dosage (as applicable) via Medicare claims
  2. Report serum phosphorus levels in CROWNWeb
  3. Administer the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey and deliver the results via a CMS-approved vendor.

The resulting scores from all of the data collection, for all 6,000 facilities, will be available on the Dialysis Facility Compare site, and each facility will be required to prominently display their Performance Score Certificate.

In 2010, there were 489,000 patients in Medicare's ESRD program at a cost of $32.9 billion. In addition to the cost, there is also an impact upon the patient's quality of life, which includes dialysis three times a week, at four hours per visit.

Engaged patients will want to compare facilities in their area to make more informed decisions on where they will receive their care. Hospital leaders will also want to review the ratings of facilities in their community and consider the impact of where their patients receive dialysis services and the potential impact on admission and readmission rates.

The dramatic rise in obesity, diabetes and hypertension creates the risk for an explosion in the number of patients requiring dialysis. More effective coordination between primary care physicians, nephrologists and vascular surgeons will be needed to ensure detection of the early signs of kidney disease.

But the risk also presents an opportunity for proactive support of patients as they self-manage and control their diabetes and hypertension.