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Section 4558 (b) of the Balanced Budget Act (BBA) requires CMS to develop and implement by January 1, 2000, a method to measure and report the quality of renal dialysis services provided under the Medicare program. To implement this legislation, CMS decided to fund the development of CPMs based on the National Kidney Foundation's Dialysis Outcome Quality Initiative (DOQI) Clinical Practice Guidelines. Phase I: On April 1, 1998, CMS awarded a contract to Qualis Health a private, non-profit health care quality improvement organization to develop a set of ESRD CPMs based on the DOQI Guidelines. Phase I of the project (April 1, 1998 - January 31, 1999) involved the prioritization of the DOQI Guidelines as to their feasibility of being converted into CPMs, the development of algorithms for the applications of the CPMs, and the development of proposed data collection instruments, data specifications and methodology for the collection of the CPMs. Sixteen ESRD CPMs (five for hemodialysis (HD) adequacy, three for peritoneal dialysis (PD) adequacy, four for anemia management and four for vascular access) were developed. Phase II: This phase, dating from February 1, 1999 - March 1, 2000, involved the pilot testing of the CPMs developed in Phase I (testing for reliability and validity). Under CMS' direction, PRO-West conducted the pilot testing of the CPMs. The pilot testing methodology was the same as that used for the ESRD Core Indicators Project (random national sample of adult HD patients, stratified by Network area, and a random national sample of adult PD patients). The pilot testing was completed in September 1999. Reports describing the results of the 1999 CPM data collection are listed below. On March 1, 1999, the ESRD Core Indicators Project was merged with the ESRD CPMs Project and the project is now known as the ESRD CPMs Project. The ESRD CPMs are similar to the core indicators with the addition of measures for vascular access. The ESRD CPMs are collected annually on a national random sample of adult hemodialysis and peritoneal dialysis patients. Phase III: To continue ESRD Quality Improvement efforts, CMS has adopted effective April 1, 2008, 26 new CPMs in order to further monitor the quality of care being delivered to ESRD patients. As data become available for these new CPMs, CMS will expand the public reporting of quality information on Dialysis Facility Compare currently available on www.medicare.gov. Currently, public reporting is limited to three measures for 100% of the ESRD population and include Hematocrit, Urea Reduction Ratio (limited to the hemodialysis population), and Survival. Additional CPM data are only collected on a 5% random sampling of the ESRD population. While this limited data sampling is insufficient for public reporting, the information is used by ESRD facilities, ESRD Networks, and State Survey Agencies to assess the quality of care being delivered. CMS is scheduled to rollout CROWNWeb in February 2009. With the availability of CROWNWeb, all ESRD facilities will be required to electronically submit data for these CPMs for 100% of their patient population. CROWNWeb will allow CMS to move away from relying on claims data for the collection of quality data thus allow CMS to publicly report more current quality data. The topic areas for the 26 measures are: - Anemia,
- Dialysis Adequacy (Hemodialysis and Peritoneal Dialysis),
- Vascular Access,
- Mineral Metabolism,
- Influenza Vaccination,
- Mortality, and
- Patient Education, Satisfaction, and Quality of Life.
Additional details about these measures are available in the document labeled Phase III ESRD CPM 04012008 Final below.
Page Last Modified: 04/01/2008 10:40:26 AM
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