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National ESRD CPM Project – Improving Quality of Care for Individuals with ESRD

National ESRD CPM Project – Improving Quality of Care for Individuals with ESRD. Thomas Dudley, MS, RN Division Chronic and Post Acute Care Quality Management and Health Assessment Group Centers for Medicare & Medicaid Services February 20, 2008. Objectives.

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National ESRD CPM Project – Improving Quality of Care for Individuals with ESRD

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  1. National ESRD CPM Project – Improving Quality of Care for Individuals with ESRD Thomas Dudley, MS, RN Division Chronic and Post Acute Care Quality Management and Health Assessment Group Centers for Medicare & Medicaid Services February 20, 2008

  2. Objectives • Discuss measure development and the endorsement process of the updated quality measures. • Describe how the updated CPMs will impact the quality of care provided to ESRD patients. • Discuss how the CPM data is and will be used by the ESRD community and the general public.

  3. Past to Present… • Section 4558 (b) of the Balanced Budget Act (BBA) requires CMS to develop and implement by January 1, 2000, a method to measure and report the quality of renal dialysis services provided under the Medicare program. • CMS decided to fund the development of CPMs based on the National Kidney Foundation’s Dialysis Outcome Quality Initiative (DOQI) Clinical Practice Guidelines. • 2007 – ESRD Quality Measure Development and Endorsement. • 2008 and Beyond….

  4. What is the REAL Reason for Measuring Quality of Care???? • We can…so we do. • Because CMS says so. • We have too much time on our hands and figured why not. • To ensure that individuals with ESRD receive the highest quality of care from their respective ESRD facilities and achieve the best possible outcomes.

  5. Who is accountable when it comes to CPMs? • You? • Me? • CMS? • ESRD Networks? • ESRD Facilities? • Nephrologists? • Dialysis Nurses? • ESRD Patients?

  6. ….and the Answer is….

  7. Current CPM Data Collection • Random sampling of patient data for each facility • 5% random sampling of all ESRD patients • HD and PD data includes adults of age 18 years or older • For HD, a national random sample of in-center hemodialysis patients is drawn, stratified by Network. • For PD, a national random sample was drawn without Network stratification. • The Pediatric HD surveys the entire population of in-center hemodialysis patients 0-18 years of age in each Network. • 16 measures in the following categories • Adequacy of hemodialysis • Adequacy of peritoneal dialysis • Vascular access • Anemia management

  8. Current Status of the New Measures • 24 measures were initially presented to the NQF voting members. • The measures included: • 1- Anemia Management (limited to assessment of iron stores; hemoglobin measures were delayed until the FDA finalized guidance for ESA therapy) • 5 – Hemodialysis Adequacy • 4 – Peritoneal Dialysis Adequacy • 2 – Mineral Metabolism • 5 – Vascular Access • 2 – Influenza Vaccination • 1 – Mortality (anticipated to be endorsed in the near future) • 4 – Patient Education/Perception of Care/Quality of Life • 23 measures were approved by the voting members and endorsed by the NQF board on November 15. • The mortality measure was originally rejected secondary to concerns about the cut points/statistical methodology for categorizing rates, these items were dropped and we anticipate endorsement soon.

  9. Status of the Anemia Management Measures - Hemoglobin • 2 revised measures submitted to NQF in November after FDA issued guidance: • <10 gm/dL for everyone with ESRD. • 10 – 12 gm/dL for ESRD individuals receiving ESA therapy. • The measure looking at the range of 10 – 12 gm/dL was rejected by the steering committee (close vote) citing concerns that the range was too narrow. • Despite the rejection of the measure, CMS is likely to make it a CPM.

  10. Data Use and Potential Future Steps Use of the data now and in the future….

  11. Use of CPM Data Today… • Help guide quality improvement efforts in ESRD facilities • Provider/Facility accountability • Public reporting

  12. Future Use of CPM Data… • 100% Reporting of CPMs by ESRD Facilities through CROWNWeb – rollout February 2009 • Late spring/early summer 2009 – analysis of initial CROWNWeb data. • Additional measures reported on DFC– fall 2009? • Increased ESRD facility accountability for patient outcomes???? • Pay for Performance????

  13. Test Time… Question: Why do we collect CPM data? Answer: Improve outcomes for individuals with ESRD!

  14. Questions?

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