How can CMS improve the quality of dialysis treatment?

Monitoring and evaluating the ESRD QIP


CMS administers the End-Stage Renal Disease Quality Incentive Program (ESRD QIP) to promote high-quality services in renal dialysis facilities. In this value-based purchasing program, CMS reduces Medicare payments to renal dialysis facilities by as much as 2% if they do not meet or exceed specific performance standards. The performance standards are revised each year, with adjustments to the measures, methodologies to score facilities, and payment reduction scale. CMS designed the ESRD QIP and the ESRD Prospective Payment System to improve outcomes in facilities that treat patients with ESRD, while at the same time lowering costs for CMS.


In 2021, Westat conducts monitoring and evaluation analyses of the ESRD QIP. 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, we are conducting the following tasks:

  • Develop and implement annual monitoring and evaluation plans
  • Conduct environmental scans and data dashboards to inform the evaluation and monitoring approach
  • Use statistical and econometric approaches to evaluate the ESRD QIP on CMS’s priority outcomes
  • Develop regular monitoring reports on 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 dialysis patients, facility staff, and other interested parties


Our reports and dashboards provide CMS with important visibility into the latest changes in health outcomes and barriers to care for patients with ESRD. The in-depth analysis and data-driven conclusions identify program impacts on beneficiary groups, facilities, and providers and assess the distributional effects of the ESRD QIP to determine the program’s effectiveness in achieving the desired outcomes of CMS rulemaking. These results inform recommendations for CMS to continue to improve the management and operations of ESRD QIP.

This project was begun by Insight Policy Research, and work is continuing by Westat.


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