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Federal Register / Vol. 86, No. 129 / Friday, July 9, 2021 / Proposed Rules b. Effects of the PY 2024 ESRD QIP on ESRD Facilities Any reductions in the ESRD PPS
payments as a result of a facilitys performance under the PY 2024 ESRD
QIP will apply to the ESRD PPS
payments made to the facility for services furnished in CY 2024, as codified in our regulations at 42 CFR
413.177.

For the PY 2024 ESRD QIP, we estimate that, of the 7,610 dialysis facilities including those not receiving a TPS enrolled in Medicare, approximately 24.4 percent or 1,799 of the facilities that have sufficient data to calculate a TPS would receive a payment reduction for PY 2024. We are presenting an estimate for the PY 2024
ESRD QIP to update the estimated impact that was provided in the CY
2021 ESRD PPS final rule 85 FR 71481

through 71483. If our proposals are finalized as proposed, the total estimated payment reductions for all the 1,799 facilities expected to receive a payment reduction in PY 2024 would decrease from $18,247,083.76 to approximately $17,154,657.12. Facilities that do not receive a TPS do not receive a payment reduction.
Table 11 shows the overall estimated distribution of payment reductions resulting from the PY 2024 ESRD QIP.

TABLE 11: Estimated Distribution of PY 2024 ESRD QIP Payment Reductions
Payment Reduction
Number of Facilities 5,570

0.0%

1,343
363
71
22

0.5%
1.0%
1.5%
2.0%
241 facilities not scored due to insufficient data To estimate whether a facility would receive a payment reduction for PY
2024, we scored each facility on achievement and improvement on several clinical measures we have
Percent of Facilities 75.59o/c
previously finalized and for which there were available data from EQRS and Medicare claims. Payment reduction estimates are calculated using the most recent data available specified in Table
18.22o/c 4.93o/c 0.96o/c 0.30o/c
12 in accordance with the policies proposed in this proposed rule.
Measures used for the simulation are shown in Table 12.

TABLE 12: Data Used to Estimate PY 2024 ESRD QIP Payment Reductions
ICH CARPS Survey SRR
SHR
PPPW
Kt/V Dialysis Adequacy Comprehensive VAT
Standardized Fistula Ratio
jbell on DSKJLSW7X2PROD with PROPOSALS2

% Catheter Hypercalcemia For all measures except the SHR
clinical measure, the Standardized Readmission Ratio SRR clinical measure, and the STrR reporting measure, measures with less than 11
patients for a facility were not included in that facilitys TPS. For the SHR
clinical measure and the SRR clinical
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Performance period
Jan 2019-Dec 2019
Jan 2019-Dec 2019
Jan 2019-Dec 2019
Jan 2019-Dec 2019
Jan 2019-Dec 2019

Jan 2018-Dec 2018

Jan 2019-Dec 2019

Jan 2018-Dec 2018
Jan 2018-Dec 2018

Jan 2019-Dec 2019
Jan 2019-Dec 2019

measure, facilities were required to have at least 5 patient-years at risk and 11
index discharges, respectively, in order to be included in the facilitys TPS. For the STrR reporting measure, facilities were required to have at least 10
patient-years at risk in order to be included in the facilitys TPS. Each
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facilitys TPS was compared to an estimated mTPS and an estimated payment reduction table that were consistent with the proposals outlined in sections IV.E and IV.F of this proposed rule. Facility reporting measure scores were estimated using available data from CY 2019. Facilities
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09JYP2

EP09JY21.013

Measure
EP09JY21.012

Period of time used to calculate achievement thresholds, 50th percentiles of the national performance, benchmarks, and improvement thresholds Jan 2018-Dec 2018
Jan 2018-Dec 2018
Jan 2018-Dec 2018
Jan 2018-Dec 2018
Jan 2018-Dec 2018