Overview

ESRD Quality Incentive Program (QIP)

Background

The ESRD QIP was established by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Section 153(c) of that act, amending Section 1881(h) of the Social Security Act (SSA), establishes a Quality Incentive Program for renal dialysis facilities.

Purpose

The ESRD QIP promotes high-quality care delivered by outpatient dialysis facilities. The first federal Value Based Purchasing (VBP) program, ESRD QIP changed the way CMS pays for the treatment of ESRD patients by linking a portion of payment directly to facilities’ performance on quality care measures. The ESRD QIP will reduce payments to ESRD facilities that do not meet or exceed certain performance standards.

Once facility information has been finalized for a given year, the ESRD QIP scores facility performance on a variety of measures based on reimbursement claims, CROWNWeb data, and data from the Center for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). Facilities have an opportunity to review these scores—and to submit a request for clarifying information and/or a formal inquiry—before CMS finalizes the scores and applies any resultant payment reductions.

Please refer to regulations finalized through annual ESRD Prospective Payment System (PPS) rulemaking for official CMS guidance on program matters.

For more information about the program, please refer to the ESRD QIP page of CMS.gov. page of CMS.gov and the frequently asked questions available in the Question and Answer (Q&A) tool. Any additional questions can be submitted through the ESRD Q&A tool.

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