Projects

CMS End-Stage Renal Disease Services Monitoring and Evaluation

Project Overview

The Centers for Medicare & Medicaid Services (CMS) implemented the End-State Renal Disease (ESRD) Services Prospective Payment System (PPS) in 2011 and the ESRD Quality Incentive Program (QIP) in 2012 to improve the quality and efficiency of treatment for ESRD, a condition of permanent kidney failure. The most common treatment for ESRD is dialysis. In January 2011, the U.S. Department of Health and Human Services changed the way Medicare pays for dialysis to a bundled payment system that includes payment for other items such as drugs previously paid for separately. With such changes, it is important to ensure improvements to efficiency do not reduce beneficiaries’ access to care. The PPS and the QIP seek to improve outcomes in facilities that treat ESRD while lowering costs for CMS.

Insight is studying the effects of the QIP and the PPS on specific patient subpopulations that may have higher unreimbursed treatment costs through—

  • Environmental scan and a data needs assessment
  • Literature review of ESRD QIP monitoring program to identify clinical- and policy-relevant measures
  • Development of monitoring performance reports to quantify the state of access to care, quality of care, and population health among Medicare beneficiaries on dialysis
  • Semistructured interviews and focus groups with key stakeholders, including ESRD dialysis patients
  • Use of statistical and econometric approaches
  • Interrupted time series analysis using historical and current Medicare claims data

Products

Needs assessment, environmental scan, evaluation plan, monitoring plan, final report