End-Stage Renal Disease Quality Incentive Program Monitoring and Evaluation

Project Overview

For this important work, Insight is monitoring and evaluating healthcare quality and outcomes among maintenance dialysis patients. The Centers for Medicare & Medicaid Services (CMS) implemented the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) in 2011 and the ESRD Quality Incentive Program (QIP) in 2012 to improve the quality and efficiency of ESRD treatment across the United States.

Under the ESRD PPS, dialysis facilities receive a bundled payment for items and services provided for the care of dialysis patients. Because the bundling of payments could negatively affect patient care, CMS implemented the ESRD QIP to promote high-quality care through incentives. That is, CMS reduces Medicare payments by as much as 2 percent for facilities that do not meet specific performance standards. Together, the PPS and the QIP are intended to improve outcomes in facilities that treat ESRD, while at the same time lowering costs for CMS.

Our team tracks dialysis quality and outcome measures for all Medicare fee-for-service dialysis patients. We also study the effect of the ESRD QIP on dialysis patients and facilities’ subpopulations with a focus on interactions between the program and traditionally underserved patient populations. Specifically, Insight is conducting the following tasks:

  • Develop and implement annual monitoring and evaluation plans.
  • Conduct an environmental scan and a data needs assessment to inform the evaluation and monitoring approach.
  • Use statistical and econometric approaches to evaluate the ESRD QIP on CMS’s priority outcomes.
  • Develop annual monitoring reports that quantify the state of access to care, quality of care, health equity, quality of life, and efficiency of dialysis care among Medicare beneficiaries on dialysis.
  • Conduct semistructured interviews with key stakeholders including dialysis patients and facility staff.


Monitoring dashboard, environmental scan, and annual and final reports