Chronic Kidney Disease: Quality Care Begins with Measurement
Business pundits often tout the notion that what gets measured gets managed. In medicine, measurement is often the essential first step toward the diagnosis and management of a problem and it helps ensure quality, evidence-based care delivery. Kidneys are an excellent example. At its onset, Chronic Kidney Disease (CKD) is asymptomatic, and only routine screening can identify it in its earliest stages. Even among at-risk populations, such as those with diabetes and hypertension, CKD often goes undetected until its later stages. Because ailing kidneys do not clearly signal problems until they are near failure, their health and performance must be routinely measured on an annual basis to determine if kidney damage is present.
Chronic kidney disease is a disease multiplier. It significantly increases risk for cardiovascular events and mortality. Annual testing, early recognition and diagnosis can slow progression and reduce rising cardiovascular risk. At present, as many as 50% of people in advanced CKD remain undetected in primary care settings.
The NKF’s CKDintercept initiative is working across the health care delivery and public health ecosystem to drive awareness and increase testing and diagnosis of CKD. The goal, as the initiative’s name suggests, is to intercept CKD’s common progression to fatal heart disease or the need for kidney replacement therapy or transplant. Proper measurement through complete testing, followed by appropriate risk stratification, disease management and timely referral improves care quality, lowers health care costs, and extends patients’ quality and length of life.
Testing & Measurement
Testing or measurement is where the process begins, but unfortunately thorough, complete testing isn’t happening among people at risk for kidney disease. In fact, an estimated 37 million Americans have CKD and only 10 percent or fewer than 4 million know it. Forty percent of people diagnosed with diabetes develop CKD, and nearly 50 percent of adults in the US have hypertension, which is both a cause and complication of CKD Among people with diabetes, 61 percent are not receiving the recommended testing. The American Diabetes Association’s (ADA) guidelines recommend patients be screened one to three times annually based on their albuminuria. Albuminuria is an essential component of chronic kidney disease diagnosis, staging, and prognosis but it is significantly underutilized, with annual testing rates of approximately 40 percent for diabetes and less than 10 percent for hypertension according to national data. These rates reflect an expansive and deeply rooted quality problem that needs to be addressed so more people at risk for CKD are tested, educated, and treated as needed.
Clinical practice guidelines from the American Diabetes Association and the National Kidney Foundation (NKF) recommend screening patients with diabetes for kidney disease every year using two tests: the estimated Glomerular Filtration Rate (eGFR) and urine Albumin-to-Creatinine Ratio (uACR).
The Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) have been strong partners in including Kidney Health Evaluation measurements in their quality and performance evaluation programs.
- The NKF partnered with NCQA to develop the Kidney Health Evaluation for Patients with Diabetes (KED) as a new measure in the Healthcare Effectiveness Data and Information Set (HEDIS®). One of health care’s most widely used performance improvement tools, HEDIS results are reported by health insurance plans that cover more than 200 million people. The new measurement is in place with the goal of improving the rate of testing for CKD among people with diabetes. Public reporting of the KED HEDIS measure will begin in late 2023.
- Effective for 2023, CMS has made the NKF’s Kidney Health Evaluation a measure in the Medicare Merit-based Incentive Payment System (MIPS), which is part of the Quality Payment Program and describes how CMS reimburses eligible clinicians for Medicare Part B covered services and rewards clinicians for improving the quality of patient care and outcomes. Click here to review the MIPS measure specifications.
- In 2023, NCQA will launch an updated Diabetes Recognition Program (DRP) to include the addition of the KED measure. The DRP recognizes clinicians who use evidence-based measures to provide high-quality ambulatory care to their patients with diabetes. Participation in the program is voluntary and recognition lasts for three years. This refresh aligns with CMS goals to increase utilization of digital quality measures.
- For 2024, Medicare Advantage and Part D plans will report against the Kidney Health Evaluation Measure for the STAR ratings system. Star ratings helps Medicare measure quality performance and help consumers compare the quality of competing Medicare health and drug plans.
The measure – for both physician practices and health plans – uses the same standard. It seeks to grow the percentage of adult health plan members/patients with either Type 1 or Type 2 diabetes who received a guideline-concordant Kidney Health Evaluation comprising an estimated glomerular filtration rate (eGFR) blood test and an albumin-creatinine ratio urine test (uACR) during the measurement year. More information for physicians is available in the NCQA’s Diabetes and Kidney Health Tool Kit.
CKDIntercept is a groundbreaking initiative from the National Kidney Foundation to improve chronic kidney disease testing, recognition and management in primary care.
For more information on the initiatives and programs within CKDIntercept:
Last Reviewed: 07/28/2023
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