prevalence of ESRD and acts to drive the ESRD research agenda.) Five of these measures are currently collected for the Agency for Healthcare Research and Quality’s (AHRQ) National Healthcare Quality Report (NHQR). Three of these are outcome measures derived from the University of Michigan. The other two are process measures from the United States Renal Data System. Additionally, the three outcome measures are currently reported on CMS’s Dialysis Facility Compare website. Also, as a requirement for payment, all facilities must already be reporting on hematocrit levels as a part of normal reimbursement procedures. The committee believes that dialysis facilities should begin reporting on the measures collected for AHRQ’s NHQR (five measures), which could be combined into an equally weighted composite score.

  • Patient-centeredness: Patients’ experiences of care will be measured by a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. As of August 2006, an In-Center Hemodialysis (ICH) CAHPS was being finalized to capture the patient’s perspective of care in dialysis facilities.

  • Efficiency: There is a dearth of efficiency measures, and until valid measures are developed, the committee believes that a system should be developed in which dialysis facilities meeting certain thresholds for both clinical quality and patient-centeredness measures are given an additional reward if they are among the most efficient one-third of dialysis facilities. The most efficient third could be calculated using methods for calculating standardized costs for Medicare. For example, Medicare standardized costs over time would be calculated using charges for Medicare Parts A and B (starting at the time of hospitalization and following charges for 90 days) using standard national prices such as an “average” payout per diagnosis-related group or resource-based relative value scale. This would be uniform for all providers and would not include disproportiante share or graduate medical education payments. Using this method, efficiency could be rewarded only when both clinical quality and patient-centered measures were available.

Timing of Pay for Performance

For dialysis facilities, measurement of the three domains is at different levels of development. As the dialysis facilities have been reporting on clinical quality measures as discussed above, the committee believes that rewards could be provided for meeting performance criteria in this domain at the beginning of year 2 (2009). As ICH-CAHPS data were being collected, dialysis facilities would be rewarded for publicly reporting performance data through Dialysis Facility Compare. Beginning in year 3 (2010), as ICH-CAHPS data became available, patient-centeredness would be rewarded based on performance. Efficiency measures could thus begin to be rewarded



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