Scoring

ESRD Quality Incentive Program (QIP)

CMS evaluates a dialysis facility’s performance in the ESRD QIP by scoring it on measures finalized during the annual rulemaking process. The ESRD QIP features two general types of measures.

  • Clinical measures evaluate facilities based on the quality of services provided to patients with ESRD regarding specific topics as finalized by rulemaking.
  • Reporting measures evaluate facilities based on whether they provided particular data during the performance period regarding specific topics as finalized by rulemaking. Reporting measures in the ESRD QIP are designed to provide baseline data upon which the program can establish future clinical measures, including the calculation of performance standards, benchmarks, and achievement thresholds.

CMS generally scores clinical measures, by applying two methods. CMS will apply the higher of the two resulting scores when calculating the facility’s Total Performance Score (TPS).

  • The Achievement method compares facility performance rates, which is how well the facility performed during the performance period, to a set of values derived from all facilities nationally. The Achievement Range runs from the Achievement Threshold (the 15th percentile of national performance during the relevant comparison period) to the Benchmark (the 90th percentile of national performance during the relevant comparison period).
    • If the facility’s performance rate is worse than the Achievement Threshold, the facility will receive zero points for their Achievement score.
    • If the facility’s performance rate is better than the Benchmark, the facility will receive the full 10 points for this measure.
    • If the facility’s performance rate is between the Achievement Threshold and the Benchmark, CMS will calculate the Achievement score using an equation finalized in rulemaking.
  • The Improvement method compares facility performance rate to the facility’s individual performance during the prior year. The Improvement Range runs from the Improvement Threshold (the facility’s own performance rate during the year prior) to the Benchmark identified earlier.
    • If the facility’s performance rate is worse than the Improvement Threshold, the facility will receive zero points for their Improvement score.
    • If the facility’s performance rate is better than the Benchmark, the facility will receive the full 10 points for this measure.
    • If the facility’s performance rate is between the Improvement Threshold and the Benchmark, CMS will calculate the Improvement score using an equation finalized in rulemaking.

For a detailed example of how these methods function using PY 2016 standards, refer to the ESRD QIP Clinical Measure Scoring Examples (PDF-974 KB) document.

For reporting measures, CMS assigns points based on whether a facility reported the required data during the performance period. CMS calculates each facility’s total performance score (TPS) based on the measure weights established for each payment year (PY). For a detailed example of this method using PY 2019 standards, refer to the ESRD QIP Clinical Measure Scoring Examples (PDF-382 KB) document.

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