Technical Specifications for ESRD QIP Measures

The End Stage Renal Disease Quality Incentive Program (ESRD QIP) was established by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Section 153(c) of that act, amending Section 1881(h) of the Social Security Act (SSA), establishes a Quality Incentive Program for renal dialysis facilities. The ESRD QIP promotes the delivery of high-quality care by dialysis facilities. The first federal Value Based Purchasing (VBP) program, ESRD QIP changed the way the Centers for Medicare and Medicaid Services (CMS) pays for the treatment of ESRD patients by linking a portion of payment directly to facilities’ performance on quality care measures.

The ESRD QIP will reduce payments to ESRD facilities that do not meet or exceed certain performance standards. Measures are formalized for each payment year (PY) through the Federal rulemaking process under the ESRD Prospective Payment System (PPS). The ESRD QIP scores facility performance for each PY’s measures using data from reimbursement claims, ESRD Quality Reporting System (EQRS), and the Center for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN).

The technical specifications for final rules can be found in the following list.

Please take note that the rulemaking process refers to calendar years (CY) for the ESRD Prospective Payment System (PPS), of which ESRD QIP regulations are a part. ESRD QIP PY refers to the year in which a payment reduction would apply as a result of facility performance. In addition, an ESRD PPS CY rule often covers more than one ESRD QIP PY. For example, the CY 2024 ESRD PPS final rule established ESRD QIP PYs 2026 - 2027.  

Current Technical Specifications of Record

The following files contain the most recent finalized technical specifications for the ESRD QIP.

• CY 2025 Proposed Technical Measure Specifications (PDF)
• CY 2024 Technical Measure Specifications (PDF)
• CY 2023 Technical Measure Specifications (PDF)
• CY 2022 Technical Measure Specifications (PDF)
• CY 2021 Technical Measure Specifications (PDF)
• CY 2020 Technical Measure Specifications (PDF)
• CY 2019 Technical Measure Specifications (PDF)
• CY 2018 Technical Measure Specifications (PDF)
• CY 2017 Technical Measure Specifications (PDF)
• CY 2016 Technical Measure Specifications (PDF)
• CY 2015 Technical Measure Specifications (PDF)

Calendar Year Final Rule Specifications

The following presentations are brief summaries of each final rule. Complete finalized policies are located on the Federal Register.

CY 2024 ESRD PPS Final Rule

• Remove the Ultrafiltration Rate (UFR) Reporting Measure beginning with PY 2026
• Remove the Standardized Fistula (SFR) Clinical Measure beginning with PY 2026
• Modify the COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) Reporting Measure beginning with PY 2026
• Convert the Clinical Depression Screening and Follow-Up Reporting Measure to a Clinical Measure beginning with PY 2026
• Add the Facility Commitment to Health Equity Reporting Measure beginning with PY 2026
• Add the Screening for Social Drivers of Health (SDOH) Reporting Measure beginning with PY 2027
• Add the Screen Positive Rate for SDOH Reporting Measure beginning with PY 2027
• Update the minimum Total Performance Score (mTPS) for PY 2026 to 53
• CY 2024 Technical Measure Specifications (PDF)

CY 2023 ESRD PPS Final Rule

• Suppression of seven measures under the measure suppression policy for the PY 2023
• Express the Standardized Hospitalization Ratio (SHR) and Standardized Readmission Ratio (SRR) clinical measures results as rates beginning with PY 2024
• Adopt COVID-19 Vaccination Coverage among Healthcare Personnel to the ESRD QIP measure set beginning with PY 2025.
• Convert the Standardized Transfusion Ratio (STrR) reporting measure to a clinical measure and express as a rate beginning with PY 2025
• Convert the Hypercalcemia clinical measure to a reporting measure and update the scoring methodology beginning with PY 2025
• Use CY 2019 data to calculate performance standards and update mTPS
  • Update the mTPS for PY 2023 to include non-paused measures
  • Re-calculate the mTPS to 83 to address addition of the Standardized Fistula Rate clinical measure  
• Create a new Reporting Measure domain and re-weight current domains beginning with PY 2025
• CY 2023 Technical Measure Specifications (PDF)

CY 2022 ESRD PPS Final Rule

The CY 2022 ESRD PPS final rule was posted by CMS on November 8, 2021. It finalized:

• Measure suppression policy for the duration of the COVID-19 PHE
• Adopt four measure suppression factors to help determine whether to suppress measures that overlap the PHE
• Update the Scoring Policy/Performance standards
• Update the Standardized Hospitalization Ratio (SHR) Measure
• CY 2022 Technical Measure Specifications (PDF)

CY 2021 ESRD PPS Final Rule

The CY 2021 ESRD PPS final rule was posted by CMS on November 9, 2020. It finalized:

• Revising the scoring methodology for the Ultrafiltration Rate (UFR) Reporting Measure
• Clarifications of the timeline to make changes to National Healthcare Safety Network (NHSN) Blood stream Infection (BSI) and NHSN Dialysis Event Reporting
• Decreasing the number of records required for the NHSN Validation CY 2021 Final technical specifications for the PY 2023 ESRD QIP (PDF) (PDF)

CY 2020 ESRD PPS Final Rule

The CY 2020 ESRD PPS final rule was posted by CMS on November 8, 2019. It finalized:

• Updating scoring methodology for the NHSN Dialysis Event reporting measure
• Converting STrR clinical measure (NQF #2979) into a reporting measure
• Codifying program requirements in regulation text
• Continuing of the NHSN validation study in PY 2023 and beyond

CY 2019 ESRD PPS Final Rule

The CY 2019 ESRD PPS final rule was posted by CMS on November 14, 2018. It finalized:

• Modifications to the PY 2021 ESRD QIP;
• Clinical and reporting measures for the PY 2022 and beyond;
• Programmatic changes and alignment with Meaningful Measures.

CY 2018 ESRD PPS Final Rule

The CY 2018 ESRD PPS proposed rule was posted by CMS on November 1, 2017. It finalized:

• Clinical and reporting measures for the PY 2021 ESRD QIP;
• Modifications to PY 2019 and PY 2020 ESRD QIP; and
• Programmatic changes.

Analyses Supporting the CY 2018 ESRD PPS Final Rule

The CY 2018 ESRD PPS final rule referenced the following analyses supporting the ESRD QIP policies made by CMS.

• ESRD Vascular Access TEP Summary Report (PDF)
• DFC Discussion Findings (PDF)
• Executive Summary of December 13, 2016 Patient Listening Session at CMS Quality Conference (PDF)
• DFC Patient Engagement Session Debrief (4/15/17) (PDF)
• PY 2017 Payment Reductions by Facility Size (PDF)

CY 2017 ESRD PPS Final Rule 

The CY 2017 ESRD PPS final rule was posted by CMS on October 28, 2016.

Final Measure Specifications for the PY 2020 ESRD QIP (PDF)

This final rule containing measures for Payment Year 2020 was posted by CMS on October 28, 2016.

Final Measure Specifications for the PY 2019 ESRD QIP (PDF)

This final rule containing revised measures for Payment Year 2019 was posted by CMS on October 28, 2016.

Final Measure Specifications for the PY 2018 ESRD QIP (PDF)

This final rule containing revised measures for Payment Year 2018 was posted by CMS on October 28, 2016.

Analysis Supporting the CY 2017 ESRD PPS Final Rule

The CY 2017 ESRD PPS final rule referenced the following analysis supporting the ESRD QIP policies made by CMS.

• Impact Analysis of Hypercalcemia Methodology Change (PDF)

CY 2016 ESRD PPS Final Rule

The CY 2016 ESRD PPS final rule was posted by CMS on October 30, 2015.

Final Measure Specifications for the PY 2019 ESRD QIP (PDF)

This final rule containing measures for Payment Year 2019 was posted by CMS on October 30, 2015.

Final Measure Specifications for the PY 2018 ESRD QIP (PDF)

This final rule containing measures for Payment Year 2018 was posted by CMS on October 30, 2015.

Final Measure Specifications for the PY 2017 ESRD QIP (PDF)

This final rule containing proposed measures for Payment Year 2017 was posted by CMS on October 30, 2015.

CY 2015 ESRD PPS Final Rule

The CY 2015 ESRD PPS final rule was posted by CMS on October 31, 2014.

Final Measure Specifications for the PY 2018 ESRD QIP (PDF)

This final rule containing measures for Payment Year 2018 was posted by CMS on October 31, 2014.

Final Measure Specifications for the PY 2017 ESRD QIP (PDF)

This final rule containing proposed measures for Payment Year 2017 was posted by CMS on October 31, 2014.

CY 2014 ESRD PPS Final Rule

The CY 2014 ESRD PPS final rule was displayed by CMS on November 22, 2013.

Final Measure Specifications for the PY 2016 ESRD QIP (PDF)

This final rule containing measures for Payment Year 2016 was displayed by CMS on November 22, 2013.

CY 2013 ESRD PPS Final Rule

The CY 2013 ESRD PPS final rule was published by CMS on November 2, 2012.

Final Measure Specifications for the PY 2015 ESRD QIP (PDF)

This final rule containing measures for Payment Year 2015 was published by CMS on November 2, 2012.

CY 2012 ESRD PPS Final Rule

The CY 2012 ESRD PPS final rule was published by CMS on November 1, 2011.

PY 2014 ESRD QIP Performance Standards (PDF)

Performance standards for Payment Year 2014 are calculated using data collected over a full year (July 1, 2010 through June 30, 2011) in accordance with the Final Rule published by CMS on November 1, 2011.

Final Clinical Measure Specifications for the PY 2014 ESRD QIP (PDF)

This final rule containing measures for Payment Year 2014 was published by CMS on November 1, 2011.

Final Measure Specifications for the PY 2013 ESRD QIP (PDF)

This final rule containing measures for Payment Year 2013 was published by CMS on November 1, 2011.