Speaker sees variability in results between ESKD quality measurement tools
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Focusing on important quality measures, providing advocacy and asking questions are important to understand the quality of care in dialysis centers, according to a speaker at the virtual National Kidney Foundation Spring Clinical Meetings.
“What we have found in our advocacy and our discussions with CMS in this process is that there are some inconsistencies between the five-star program and the [quality incentive program] QIP, which sometimes can be misleading,” Keith A. Bellovich, DO, chief medical officer at Ascension St. John’s Hospital and a practicing nephrologist with St. Claire Multispecialty Group in Michigan, said in his presentation. “Some of these measures can be without validity or reliability, and we are constantly advocating to find realistic and appropriate outcome measures among our facilities.”
In the QIP, the Medicare payment to the facility is adjusted based on the performance score it receives for a number of quality measures, Bellovich said. A facility with a performance score of 59 or higher in the QIP would not get any penalty. Scores between 49 and 59 receive a 0.5% reduction in payments for that facility, scores between 39 and 48 receive a 1% reduction, and scores between 29 and 38 receive up to a 2% reduction.
The problem, he said, appears when the results from the two quality measurement tools for the same facility are compared. Bellovich found some clinics had been penalized in the QIP program for a low performance score yet received four to five stars in the Dialysis Facility Compare rating, and facilities without any QIP penalties received a one- to two-star rating.
Kidney Care Partners, an advocacy group with members from kidney care associations, providers and industry, recommends that patients focus on measures that are most important to them in deciding where to have dialysis, Bellovich said. Asking questions of other patients, caregivers, hospital systems or health systems in the community also may be beneficial.
“The concept of trust but verify is still always the best way to identify what truly is a high-quality unit,” Bellovich said. – by Erin T. Welsh
Reference:
Bellovich KA. Quality measure controversies in dialysis care. Presented at: National Kidney Foundation Spring Clinical Meetings; March 26-29, 2020 (virtual meeting).
Disclosure: Bellovich reports he is a medical director and Joint Venture partner with DaVita, is an executive officer with Renal Physicians Association and is on the member operations committee of Kidney Care Partners.
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