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Federal Register / Vol. 86, No. 129 / Friday, July 9, 2021 / Proposed Rules payment reduction is approximately $17,154,657.121. Facilities that do not
receive a TPS do not receive a payment reduction.

Table 14 shows the overall estimated distribution of payment reductions resulting from the PY 2025 ESRD QIP.

TABLE 14: Estimated Distribution of PY 2025 ESRD QIP Payment Reductions
0.0%

Number of Facilities 5,570

Percent of Facilities 75.59o/c
0.5%

1,343

18.22o/c
1.0%
1.5%

363

4.93o/c
71
22

0.96o/c 0.30o/c
Payment Reduction
2.0%
Note: 241 facilities not scored due to insufficient data To estimate whether a facility would receive a payment reduction in PY 2025, we scored each facility on achievement and improvement on several clinical measures we have previously finalized
and for which there were available data from EQRS and Medicare claims.
Payment reduction estimates were calculated using the most recent data available specified in Table 14 in
accordance with the policies finalized in this proposed rule. Measures used for the simulation are shown in Table 15.

TABLE 15: Data Used to Estimate PY 2025 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 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 SHR and SRR, 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 facilitys TPS was compared to an estimated mTPS and an estimated payment reduction table that
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incorporates the policies outlined in section IV.E and IV.F of this proposed rule. Facility reporting measure scores were estimated using available data from CY 2019. Facilities were required to have at least one measure in at least two domains to receive a TPS.
To estimate the total payment reductions in PY 2025 for each facility resulting from this proposed rule, we multiplied the total Medicare payments to the facility during the 1-year period between January 2019 and December 2019 by the facilitys estimated payment reduction percentage expected under
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the ESRD QIP, yielding a total payment reduction amount for each facility.
Table 16 shows the estimated impact of the finalized ESRD QIP payment reductions to all ESRD facilities for PY
2025. The table details the distribution of ESRD facilities by size both among facilities considered to be small entities and by number of treatments per facility, geography both rural and urban and by region, and facility type hospital based and freestanding facilities. Given that the performance period used for these calculations differs from the performance period we are proposing to use for the PY 2025

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