As we digest the gigantic final payment rule for ESRD by CMS, details of the plan are surfacing. One of the more interesting pieces in the policy is the introduction of QIP. QIP is more than just another cute acronym... it is a game changer.
QIP stands for Quality Incentive Program.
The new ESRD QIP will align the dialysis provider's payment to performance standards (carrot)... and conversely will lead to 2% reduction in payment if quality measures are not met (stick).
“The new payment system and quality incentive program for dialysis services have significant potential to improve patient outcomes and promote efficient delivery of healthcare services,” said CMS Administrator Donald Berwick, MD. “In addition, for the first time in any of our payment systems, the quality of care facilities furnish to patients will be reflected in their payment rates.”
For now the performance measurements will focus on anemia management and overall efficacy of dialysis treatments (through urea reduction ratios (URR)).
To hammer home the QIP effect, the proposal also calls for the public reporting of individual facility performance scores.
In principle, I am in favor of P4P (pay for performance) type arrangements. Unfortunately the reality is that there are factors beyond the control of the dialysis facility and physician providers. The targets chosen seem to be the lower hanging fruit. I am glad to see they didn't try to incentivize / penalize phosphorous levels for instance. This would be much more controversial. There is certainly more to come on this.... CMS is accepting comments on the QIP proposal until September 24th and the rule is expected by the end of the year.
For further commentary on the CMS ruling on the dialysis payment bundle I suggest you check out Bill Peckham's post on Dialysis from the Sharp End of the Needle.
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