Putting a Price on Quality:

Washington, DC
December 2, 2004

As the number of patients suffering from End Stage Renal Disease (ESRD) and the cost of their collective care rises, federal agencies are recommending the establishment of payment for quality measures to improve efficiency and increase nationwide uniformity. Given the significance of potential revisions to performance measures within ESRD, The American Society of Nephrology (ASN) and National Kidney Foundation (NKF) recently analyzed key factors involved in developing a quality-based healthcare program. Their findings appear in the December issue of the Journal of the American Society of Nephrology (JASN) entitled, “Payment for Quality in End-Stage Renal Disease.”

This paper, a result of discussions among last winter’s working group of healthcare providers, doctors, researchers, and government policy officials, examines the ESRD system of payment and whether this system can be modified to promote quality-based care delivery. The most significant issue addressed within the paper is the need to define and measure quality care to facilitate improvement in desired patient outcomes. Another serious concern is the importance of avoiding financial incentives that may lead to “cherry picking” of patients, in which caring for healthier patients may allow defined quality targets to be reached more readily. Other challenges include development of information systems, patient accessibility to dialysis centers, creation of a case-mix adjusted payment system, and establishment of accurate reporting systems to measure outcomes.

Jonathan Himmelfarb, MD of the Maine Medical Center in Portland and Chair of ASN’s Dialysis Advisory Group is the lead author of this paper. He believes this system is possible through a commitment among physicians, providers, and the Centers for Medicare & Medicaid Services (CMS) to work together to develop a new model for dialysis reimbursement that is patient-focused and fair to all parties involved. “The ASN and NKF look forward to an open discussion among key stakeholders of the concepts, data, and appropriate metrics for a quality based payment system for dialysis care,” Dr. Himmelfarb said.

In early 2005, ASN’s Policy and Public Affairs Director, Paul C. Smedberg, Dr. Himmelfarb, and others will deliver this paper to key officials at CMS to encourage discussions between CMS, ASN, and NKF to address concerns cited within the paper. “Payment for Quality in End-Stage Renal Disease” is available on the ASN website at www.asn-online.org and in the December issue of JASN.

The ASN is a not-for-profit organization of 9,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases.

The National Kidney Foundation is the nation's leading voluntary health organization seeking to prevent kidney and urinary tract diseases, improve the health and well-being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation.