Table 3.

Evolution of the CMS QIP: 2012–2014 (2,20)

QIP Element201220132014a
Clinical measuresHemodialysis adequacy (URR ≥65% in >96% of patients)Hemodialysis adequacy (URR ≥65% in 96% of patients)Hemodialysis adequacy (URR ≥65% in >91% of patients)
Minimum Hb (<10 g/dl in <2% of patients)Maximum Hb (>12 g/dl in ≤14% of patients)
Maximum Hb (>12 g/dl in <26% of patients)Maximum Hb (>12 g/dl in <16% of patients)Vascular access type (fistula in ≥44% and catheter in ≤24%)
Process measures (all yes or no)NoneNoneDialysis event reporting
Patient survey with ICH CAHPS
Mineral metabolism monitoring
Minimum Hb level10 g/dLNoneNone
Measure weighting50% Hb <10 g/dlMeasures weighted equally90% clinical measures, each of equal weightb
25% to two other measures10% process (yes/no) measures, each of equal weightc
Performance score for full paymentd26–3030Likely 56 points
  • CMS, Centers for Medicate and Medicaid Services; QIP, Quality Incentive Program; URR, urea reduction ratio; Hb, hemoglobin; ICH CAHPS, In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems Survey.

  • a The 2014 performance standard levels are the achievement thresholds described in the QIP final rule. Facilities below the achievement threshold will receive 0 points on that performance measure, with points increasing incrementally as a facility’s score rises above the achievement threshold. There are incentives for improvements in performance that are not included here that may result in a facility receiving points despite being below the achievement threshold.

  • b CMS proposes to determine performance standards based on national data collected between July 1, 2010 and June 30, 2011 for the first five measures listed.

  • c CMS proposes that facilities will attest on a yes/no basis whether they have complied with the last three “structural/reporting” process measures.

  • d Thirty points on a performance score are available in 2012 and 2013. The minimum hemoglobin measure carried 50% of the weight in the 2012 QIP, with the other two metrics weighed at 25% each. The two metrics for 2013 are equally weighted, with the number of points for each metric multiplied by 1.5 to achieve a 30-point scale. In 2014, CMS proposes a 100-point scale.