Kidney Health Evaluation Measure

The National Kidney Foundation (NKF) has developed new measures to improve chronic kidney disease (CKD) testing in people with diabetes.

The intent of these measures is to improve rates of comprehensive kidney health evaluation in patients with diabetes in an effort to more consistently identify and treat chronic kidney disease (CKD) in this high-risk population. Annual kidney health evaluation in patients with diabetes to determine risk of CKD using estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (uACR) is recommended by clinical practice guidelines^1-3 and has been a focus of various local and national health care quality improvement initiatives, including Healthy People 2020. However, performance of these tests in patients with diabetes remains low, with rates limited by low uACR testing that vary across Medicare (41.8%) and private insurers (49.0%).⁴

To address gaps in care, NKF has developed HEDIS and MIPS measures for Kidney Health Evaluation for Adults with Diabetes. The HEDIS measure was released in 2020 and is part of HEDIS Measurement Year 2022. The MIPS measure has been submitted and is currently on the Measures Under Consideration list for 2022 which means it could be included in the MIPS program this year. Both measures assess the percentage of adults with diabetes that receive comprehensive kidney health evaluation during a 12-month period. The HEDIS measure evaluates claims data. The MIPS measure evaluates information found in electronic health records.

HEDIS MEASURE

Kidney Health Evaluation for Adults with Diabetes HEDIS Measure:.

Uses information found in healthcare claims data to determine the percentage of people with diabetes that have received both eGFR and uACR in a 12-month period.

Searches for healthcare payment related information to evaluate if the measure is satisfied. This information includes Current Procedure Terminology (CPT) codes for kidney disease testing.

The July 2020 HEDIS® Journal included this measure. For more detailed information on this measure may be found on the HEDIS website: https://blog.ncqa.org/kidneyhealth/

MIPS MEASURE

Kidney Health Evaluation for Adults with Diabetes MIPS Measure

Uses information found in electronic health record data to determine the percentage of people with diabetes that have received both eGFR and uACR in a 12-month period.

Searches for clinical information in patient's health records to evaluate if the measure is satisfied. This information includes laboratory and standard medical terminology codes for kidney disease testing.

Merit-based Incentive Payment System (MIPS) was designed by the Centers for Medicare and Medicaid Services (CMS) to tie clinician payments to quality and cost-efficient care, drive improvement in care processes, and enhance health outcomes.

If you are interested in testing this measure, or would like additional information about this new measure, please contact Elizabeth Montgomery.

1. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019;42:S124-S38.
2. KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update. American Journal of Kidney Diseases 2012;60:850-86.
3. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. American Journal of Kidney Diseases 2007;49:S12-S154.
4. Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2018 Annual Data Report: Epidemiology of Kidney Disease in the United States. American Journal of Kidney Diseases 2019;73:A7-A8.