Public Policy Series How the ESRD Quality Incentive Program Could Potentially Improve Quality of Life for Patients on Dialysis

For over 20 years, the quality of medical care of the Medicare ESRD Program has been a concern. The Centers for Medicare andMedicaid Services have implemented the ESRDQuality Incentive Program,which uses the principles of value-based purchasing; dialysis providers are paid for performance on predefined quality measures, with a goal of improving patient outcomes and the quality of patient care. The ESRDQuality Incentive Programmeasures have been criticized, because they are largely disease oriented and use easy-to-obtain laboratory-based indicators, such as Kt/V and hemoglobin, that do not reflect outcomes that are most important to patients and have had a minimal effect on survival or quality of life. A key goal of improving quality of care is to enhance quality of life, a patient-important qualitymeasure that mattersmore tomany patients than even survival. None of the ESRDQuality Incentive Program measures assess patient-reportedquality of life. As outlined in theNationalQuality Strategy, theCenters forMedicare andMedicaid Services areholding providers accountable in six priority domains, inwhich qualitymeasures havebeen and are being developed for value-based purchasing. Three measures—patient experience and engagement, clinical care, and care coordination—are particularly relevant to quality care in the ESRD Program; the 2014 ESRD Quality Incentive Program includes six measures, none of which provide data from a patient-centered perspective. Value-based purchasing is awell intentioned step to improve care of patients on dialysis.However, the Centers forMedicare and Medicaid Services need to implement significant change in what is measured for the ESRD Quality Incentive Program to be patient centered and aligned with patients ’ values, preferences, and needs. This paper provides examples of potential quality measures for patient experience and engagement, clinical care, and care coordination, which if implemented,would bemuchmore likely to enhance quality of life for patientswith ESRD thanpresent ESR