Payment

ESRD Quality Incentive Program (QIP)

Payment reductions for ESRD QIP facilities are calculated based on how a facility’s Total Performance Score (TPS) compares to the minimum TPS (mTPS) established for each payment year (PY). The mTPS is the minimum score a facility must reach in order to avoid a payment reduction. CMS calculates the mTPS according to the following approach.

  • Score each clinical measure using the national performance standard for that measure (50th percentile).
  • Score each reporting measure as equal to the median score achieved by all facilities in the performance year.
  • Establish the mTPS by using these individual measure scores to calculate a TPS.

CMS compares a facility’s TPS to the mTPS to determine the appropriate payment-reduction percentage, if any, that it will apply to facility reimbursement during the PY. The following table shows the TPS ranges and the associated payment-reduction percentages that CMS will apply.

The following tables identify the mTPS and payment reduction ranges for selected PYs.

PY 2018 TPS Range Payment Reduction
49 (mTPS) – 100 points 0%
39 – 48 points

0.5%

29 – 38 points

1.0%

19 – 28 points

1.5%

0 – 18 points

2.0%


PY 2019 TPS Range Payment Reduction
60 (mTPS) – 100 points 0%
50 – 59 points

0.5%

40 – 49 points

1.0%

30 – 39 points

1.5%

0 – 29 points

2.0%


PY 2020 TPS Range Payment Reduction
59 (mTPS) – 100 points 0%
49 – 58 points

0.5%

39 – 48 points

1.0%

29 – 38 points

1.5%

0 – 28 points

2.0%

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