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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. The new CPMs were developed by experts in the ESRD community and based on the National Kidney Foundations guidelines, Kidney Disease Outcomes Quality Initiative (KDOQI? Recommendations that were compiled by the ESRD experts for many of the new CPMs from the experts in the ESRD community can be viewed in the document labeled "ESRD TEP Final Report 05212008." Information about KDOQI?20is available on the National Kidney Foundations website, www.kidney.org/professionals/KDOQI/. Most of the new CPMs have been endorsed by the National Quality Forum (NQF) via the National Voluntary Consensus Standards process as required under the National Technology Transfer and Advancement Act ( NTTAA ). Four of the 26 new CPMs were not endorsed by the NQF, but have been adopted by CMS as CPMs. The Hemodialysis Adequacy - Urea Reduction Ratio (URR) >65% and Anemia Management - Hematocrit <30% Regardless of Erythropoietin Stimulating Agents (ESA) measures were included because they mirror endorsed hemodialysis adequacy and anemia management measures that received endorsement, are measures that are currently available on Dialysis Facility Compare, and CMS currently only has access to URR and Hematocrit data that is submitted via ESRD claims. CMS will retire these two CPMs and replace them with the endorsed Hemodialysis Adequacy and Anemia Management measures when CROWNWeb data becomes available. Two additional Anemia Management CPMs did not receive NQF endorsement, but have been adopted by CMS. The measures are for Hemoglobin 10 - 12 g/dL and Hematocrit 30% - 36% for ESRD patients receiving ESAs. The NTTAA states that the government must use voluntary consensus based standards as opposed to government only standards when available and must have a justification for adopting a measure that has not been endorsed. In the case of these two anemia measures, CMS is using the November 2007 FDA guidance as our rationale for adopting this measure. The FDA Alert dated November 8, 2007 states, "The dosing recommendations for anemic patients with chronic renal failure have been revised to recommend maintaining hemoglobin levels within 10-12g/dL." Further support for adopting these measures is available in the document labeled "Anemia Summary 05212008" 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: 12/30/2008 12:23:53 PM
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