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ESRD Quality Incentive Program (QIP)

The ESRD Quality Incentive Program (QIP) is described in Section 1881(h) of the Social Security Act, as added by Section 153(c) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). This is designed to promote patient health by providing a financial incentive for renal dialysis facilities to deliver high-quality patient care.

Section 1881(h): Authorizes payment reductions if a facility does not meet or exceed the minimum Total Performance Score (TPS) as set forth by CMS Allows payment reductions of up to 2%.  
MIPPA requires the Secretary of the Department of Health and Human Services (HHS) to create an ESRD QIP that will:

  1. Select measures
  2. Establish performance standards that apply to individual measures
  3. Specify the performance period for a given PY
  4. Develop a methodology for assessing total performance of each facility based on performance standards for measures during a performance period
  5. Apply an appropriate payment percentage reduction to facilities that do not meet or exceed established total performance scores
  6. Publicly report results through Web sites and facility posting of performance score certificates (PSC)

ESRD Dialysis Facilities in Network 4 should have a complete understanding and knowledge of the ESRD QIP.  This awareness may help prevent reduction in payments to ESRD facilities that do not meet or exceed certain performance standards. Facilities must also be aware of the two percent maximum payment reduction CMS can apply to any facility, and the fact that this reduction will apply to all payments for services performed by the facility receiving the reduction during the applicable payment year (PY). The foundation, principles and mechanisms guiding the ESRD QIP will remain the same over time, but the program’s specific quality measures, standards, weights and formulas will change from year to year.

For more information about the ESRD QIP, visit on the CMS website.