ESRD Quality Incentive Program (QIP)

Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) Section 153(c) requires CMS to use certain types of quality measures as part of the ESRD QIP each year. The ESRD QIP must include measures for anemia management and dialysis adequacy; it also includes measures of patient satisfaction, iron management, bone mineral metabolism, and vascular access as specified by the Secretary of the Department of Health and Human Services (HHS).

The annual ESRD Prospective Payment System (PPS) rulemaking process allows CMS to create ESRD QIP rules that specify the measures, scoring methods, and payment-reduction ranges applicable to that payment year (PY).

Currently, the ESRD QIP employs two types of measures:

  • Clinical measures score facilities based on the quality of services provided to patients with ESRD with regard to anemia management, dialysis adequacy, vascular access, infections, and bone mineral metabolism.
  • Reporting measures encourage facilities to provide data upon which the program can establish future clinical measures, including the calculation of performance standards, benchmarks, and achievement thresholds. CMS scores facilities based on whether they provided particular data during the performance period.

A dialysis facility’s total performance score for PY 2018 – measuring facility performance during 2016 – is based on the following measures.

Table 1: Clinical Domain Measures

Subdomain Measure(s)
Safety Subdomain NHSN Bloodstream Infection
Patient and Family Engagement/
Care Coordination Subdomain


Standardized Readmission Ratio (SRR)

Clinical Care Subdomain

Kt/V Dialysis Adequacy (Four)

  • Adult Hemodialysis
  • Adult Peritoneal Dialysis
  • Pediatric Hemodialysis
  • Pediatric Peritoneal Dialysis

Vascular Access Type (Two)

  • Fistula
  • Catheter


Table 2: Reporting Domain Measures

Subdomain Measure
N/A Mineral Metabolism
N/A Anemia Management
N/A Pain Assessment and Follow-Up
N/A Clinical Depression Screening and Follow-Up
N/A NHSN Healthcare Personnel Immunization

Refer to the ESRD QIP Summary Payment Years document for elements of the program established for PY 2016 through PY 2020.

Technical Specifications

As part of proposing and finalizing rules, CMS issues technical specifications for each clinical and reporting measure. The following files contain the most recent finalized technical specifications for the ESRD QIP.

CMS ESRD Measures Manual

The CMS ESRD Measures Manual (Manual) contains the detailed specifications that underwrite clinical performance measures in the ESRD QIP and Dialysis Facility Compare (DFC). CMS recognizes that seemingly minor and esoteric aspects of the measure specifications may have a substantial impact on measure scores. Accordingly, the Manual provides a transparent and detailed description of how CMS ESRD measures are calculated, offering the public a comprehensive understanding of how CMS evaluates the quality of care provided by dialysis facilities.

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