Centers for Medicare & Medicaid Services (CMS) Activities
- Professional Education & Outreach
- Quality Improvement/Evidence of Therapy
- Delivery & Payment of CKD Care
Professional Education and Outreach
This section describes education and outreach to health professionals of the Federal government related to chronic kidney disease.
Medicare Learning Network: As a means to reach professionals, the End Stage Renal Disease Quality Incentive Program (QIP) team utilizes the Medicare Learning Network (MLN) to provide an overview of the Proposed and Final Rule for the QIP. CMS provides outreach, communication, and training on important QIP matters. These include Town-hall meetings, WebEx seminars, publication of important notifications via memorandums and official letters to the Networks and dialysis facilities, and yearly calls to the facilities to explain its preliminary Performance Score Report. CMS also utilizes the Medicare website to provide updates and information on the QIP regularly during the course of the year.
Quality Net: Yearly CMS joins nearly 1,000 thought leaders in American health care quality improvement at a premier Federal learning and action event called “Quality Net”. In addition to MLN described above, CMS also engages and reaches providers through “Quality Net”, in which solutions are engineered regarding healthcare quality improvement. Together, patients, advocates, researchers, and thought leaders in health care quality improvement catalyze grassroots, and develop “real-world” solutions to some of America’s biggest health system challenges.
ESRD Networks: The current ESRD Network Organization Statement of Work (SOW) contract performance objectives are delineated into tasks to be conducted by ESRD Network contractors in support of achieving national quality improvement goals and statutory requirements. The Network promotes better care for individuals through beneficiary and family centered care, better health for the ESRD population, and reducing costs of ESRD care by improving care. To achieve this, the Networks serves as partners in quality improvement with beneficiaries, practitioners, health care providers, other health care organizations, and other stakeholders; and disseminate best practices, including those related to clinical care, quality improvement techniques, and data collection.
Learning and Action Network (LAN) Methodology: CMS educates consumers and professionals through LANs, mechanisms that are large scale and sustainable methodologies. The ESRD Network plans to convene and support two LANs. The Patient Engagement LAN focuses on consumers and plans to recruit Patient Subject Matter Experts to provide a patient perspective for Network improvement activities, including identifying ways to spread best practices and design and implement Quality Improvement Activities. The Healthcare Associated Infections (HAI) LAN focuses on providers and facilities and will promote quality improvement by collaborating with facility management, training and educating staff and patients, and facilitating easy access to infection control policy and procedure. Networks will use the overarching recommendations resulting from the LAN for the prevention of HAI’s in ESRD facilities.
Teresa Titus- Howard
Quality Improvement Programs
This section describes current quality improvement and evidence of therapy programs of the Federal government related to chronic kidney disease.
Centers for Medicare & Medicaid Services
ESRD Quality Incentive Program: The first program of its kind in Medicare, the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) promotes high-quality outpatient care for patients with ESRD by linking a portion of each facility’s reimbursement for dialysis treatment directly to its performance on measures selected by the Centers for Medicare & Medicaid Services (CMS). Changes in reimbursement systems (via the ESRD Prospective Payment System) and an increased emphasis on patient outcomes (as embodied by CMS’s Value-Based Purchasing efforts) may result in unintended consequences for Medicare beneficiaries; for example, facilities may undertreat patients in order to maximize profits and minimize costs. The ESRD QIP helps guard against that possibility by evaluating the quality of care that dialysis facilities provide. The ESRD QIP reduces payments (by up to two percent) to facilities that do not meet or exceed certain performance standards, and the program communicates the results to the facilities themselves and the public at large.
The ESRD QIP includes clinical measures (which evaluate the quality of care provided by facilities) and reporting measures (which evaluate whether facilities collect and/or report data to CMS). These performance measures change from year to year. Currently, ESRD QIP measures address:
- Anemia Management
- Dialysis Adequacy
- Vascular Access
- Mineral Metabolism
- Patient Experience of Care
In addition, CMS is committed to improving the quality of care delivered to beneficiaries, as well as ensuring that access to care is not impeded - especially to racial and ethnic minorities, as well as other medically underserved populations. CMS closely monitors practice patterns as well as patient outcomes; if it discovers issues with regard to access, cost, or quality of care, then the facility involved will be thoroughly investigated, followed by appropriate and timely corrective action.
ESRD Quality Measures Development Program: The Quality Measurement and Health Assessment Group at CMS is responsible for the development, maintenance, and implementation of quality measures for dialysis facilities certified by Medicare. The group supports other CMS components in implementing these measures for value-based purchasing through the QIP, quality reporting, and public reporting through the Dialysis Facility Compare website. Measures developed and currently maintained address quality of care provided to dialysis patients in the areas of dialysis adequacy, anemia management, mineral bone disease, vascular access, hospitalizations, rehospitalizations, and mortality. Ongoing work is expanding these measures to assess quality as defined in the CMS Quality Strategy.
Conditions for Coverage Program: The Center for Clinical Standards and Quality’s (CCSQ) clinical standards group develops and maintains the ESRD conditions for coverage, the minimum health and safety requirements that dialysis facilities must meet in order to participate in Medicare. These conditions (found at 42 CFR Part 494) set requirements for infection control, water and dialysate quality, reuse of hemodialyzers and bloodlines, physical environment, patient’s rights, patient assessment, patient plan of care, care at home, quality assessment and performance improvement, special purpose dialysis facilities (for example, summer camps), laboratory services, personnel qualifications, responsibilities of the medical director, medical records, and governance. The group collaborates with fellow CMS and HHS components, as well as with external stakeholders, to ensure that these standards are up to date and effectively interpreted and applied.
Lauren E. Oviatt
Survey and Certification Program:The Survey and Certification Group of CMS is responsible for ensuring that all Medicare-certified ESRD facilities meet Federally-mandated standards, which are set to protect the health and safety of the ESRD patients. The standards include safety, clinical care, and infrastructure standards which are critical elements for the well-being of patients.
- Safety standards include: infection control practices; water treatment and dialysate preparation elements; reprocessing activities; and equipment/structural maintenance.
- Clinical standards include: review of the facility’s capacity to monitor, recognize, and address individual clinical care issues and the facility-wide quality assessment and performance improvement (QAPI) program. Patients’ rights are also reviewed.
- Infrastructure standards include: personnel qualifications; medical recording structure; the and governance structure
The survey process is conducted by specifically-trained health care professionals (based in State health departments) who conduct on-site facility reviews. These surveyors utilize national/facility data, national/community-based standards, patient/personnel interviews, observations of facility practices, and review of medical records to conduct their reviews. The surveyors follow-up on each survey by monitoring the appropriateness of corrective action plans and program improvements.
Dialysis Facility Compare:The Dialysis Facility Compare (DFC) contains information about Medicare certified dialysis facilities. Included is facility name and contact information, location, types of services provided, certification date, and quality measures for each facility. DFC allows patients, family members, healthcare providers, and stakeholders, to compare the quality of dialysis facilities across the country, and to access a variety of kidney disease and dialysis resources. DFC also includes demographic data, medical claims, payment, and entitlement data on patients with Medicare who have ESRD; and aggregate ESRD patient information.
Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb) - CMS utilizes CROWNWeb data as one of the primary data sources for the Quality Measures (QM) Project, enabling ESRD stakeholders to gauge patient care outcomes by offering comparisons of clinical performance results at the facility, ESRD Network, and national levels. The database can quickly calculate and produce QM reports, allowing facilities to more closely monitor patient clinical measures and rapidly evaluate treatment trends to ensure patients receive the appropriate treatment. CROWNWeb data reporting of attestations are used to calculate facility Total Performance Scores as part of the Quality Incentive Program (QIP). Facilities are evaluated and scored based on their compliance with CMS-mandated reporting measurements. Using CROWNWeb (and other) data sources, scores are calculated for each facility, and score certificates must be published in a visible area in each facility.
Delivery & Payment of ESRD Care
This section describes delivery and payment of chronic kidney disease care provided by the Federal government.
Centers for Medicare & Medicaid Services (CMS)
The Medicare End Stage Renal Disease Program is a national health insurance program for people with end stage renal disease (ESRD). Initially, ESRD Network areas were established to encourage self-care dialysis and kidney transplantation and to clarify reimbursement procedures in order to achieve more effective control of the costs of the renal disease program. Subsequently, the Social Security Act was amended to establish at least 17 ESRD Network areas and to revise the Network Organizations responsibilities.
Currently, 18 ESRD Network Organizations exist under contract to CMS and serve as liaisons between the federal government and the providers of ESRD services. Their work is intended to align Network activities with the Department of Health and Human Services (HHS) National Quality Strategy (NQS), the CMS Three Aims, and the CMS Quality Strategy priorities designed to produce improvements in the care of individuals with ESRD. The new approach facilitates a heightened focus on patient and family centered concerns and aims to promote better access to care.
The number and concentration of ESRD beneficiaries in each area define the Network Organizations geographically. Some Networks represent one state, and others represent multiple states. The ESRD Network Organizations' responsibilities include: the quality oversight of the care ESRD patients receive, the collection of data to administer the national Medicare ESRD program, assisting patients with grievances and access to care issues, and the provision of technical assistance to ESRD providers and patients in areas related to ESRD. In addition, the ESRD Network Coordinating Center (NCC) provides centralized coordination and support for the ESRD Network Program. The NCC's primary responsibilities include collection, maintenance and distribution of ESRD information; coordination of national activities, including training initiatives; facilitation of special projects, and administrative support services, such as the planning of meetings and summary reports for ESRD Networks and CMS' ESRD Network Program.
This information was reviewed by KICC agency representatives. It may not reflect new or future agency activities. For more information, please contact the listed representatives.