Measure Development

April 2008 – CMS Phase III developed 26 new facility level CPMs in order to further monitor the quality of care being delivered to ESRD patients.

Little involvement on an organizational level. A few RPA members were involved in the Clinical Technical Expert Panels. 

The adult ESRD measures received a time-limited endorsement from NQF. The pediatric measures were not endorsed by NQF. As of December 2010, the CKD measures had not been submitted to NQF because there had not been a “call for CKD measures”.

RPA is a voting member of AMA PCPI and frequently consults with content experts.

Measure Review - Endorsement and Adoption

RPA submitted 4 nominees to serve on the ESRD Steering Committee; 3 were appointed in 2010.
RPA, in conjunction with AMA PCPI, submitted 8 measures during the NQF's call for renal measures in June 2011. It is expected that these measures will be reviewed by the NQF CSAC on Aug 16-17, 2011.

Measure Implementation

Notes:
Earning an EHR incentive in 2011 does not exempt an eligible professional from the payment adjustment. Incentive not available to professionals receiving 2011 incentive from Medicare EHR Incentive Program (Meaningful Use program).

Established by the American Recovery and Reinvestment Act (ARRA) of 2009, to acknowledge the necessity of implementing widespread use of electronic health records (EHRs) and the fact that doing so would be prohibitively expensive for most medical practices. To address the necessity and cost-prohibitive concerns regarding EHR implementation, ARRA made a $19 billion investment intended to assist physicians and hospitals in purchasing EHR systems.
 
Under the Medicare incentive program, each eligible professional (non-hospital based) may qualify for up to $44,000 in Medicare incentives over a five-year period beginning in 2011. Eligible professionals (EPs) who furnish more than 50 % of covered services in a geographic Health Professional Shortage Area (HPSA) are eligible for an additional 10 % incentive on top of the maximum incentive payment amount.

The program began Jan 1, 2011. Eligible Professionals must complete 15 core objectives; 5 objectives out of 10 from menu set; and 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 38 from additional set).

CMS must submit a Report to Congress on the Physician Compare Web site by January 15, 2015. CMS is authorized to establish a demonstration program by January 1, 2019, to provide financial incentives to Medicare beneficiaries who are furnished services by high quality physicians. CMS held a town hall on Oct 27, 2010 to solicit input from stakeholders.

Implements a quality incentive program (QIP) for Medicare outpatient ESRD  providers and facilities with payment consequences beginning January 1, 2012. The proposed ESRD QIP would reduce ESRD payments by up to 2% for dialysis providers and facilities that fail to meet or exceed a total performance score for performance standards established with respect to certain specified measures.

Year 1 includes 1 hemodialysis adequacy measure and 2 anemia management measures. Although QIP payment reductions do not occur until Jan. 1, 2012, the performance period would need to occur before 2012 to allow enough time for claims processing and to evaluate facilities’ performance.
 
The final rule was issued December 27, 2010.

Facilities that do not meet or exceed performance standards will be subject to a payment reduction up to 2 percent. ESRD QIP payment adjustments will apply to payments under the ESRD PPS for outpatient maintenance dialysis items and services furnished to Medicare patients by ESRD facilities between Jan. 1, 2012 and Dec. 31, 2012.

At the time of application, be previously certified in internal medicine by ABIM; Satisfactorily complete the requisite graduate medical education fellowship training; Demonstrate clinical competence in the care of patients; Meet the licensure and procedural requirements; and Pass the Certification Exam in Nephrology.

The Accountable Care Act (ACA) requires a mechanism whereby an eligible professional may provide data on quality measures through a maintenance of certification program (MOC) operated the American Board of Medical Specialties (ABMS) or an equivalent program. MOC Programs wishing to enable their members to be eligible for an additional PQRS incentive payment for the 2011 Physician Quality Reporting System will need to go through a self-nomination process by January 31, 2011.
 
Rules concerning MOC for 2012 were included in the proposed Medicare Fee Schedule released July 1, 2011.

Ongoing monitoring and collaboration with ASN. Nephrology Self-Assessment Program Modules is being developed by ASN.

Overview of Maintenance of Certification 
Practice Performance Modules 
Nephrology Blueprint 
ASN Nephrology Self-Assessment Program (NephSAP)
PQRS and MOC (CMS)  
MOC Guide for Nephrologists