Quality Measures for Dialysis: Time for a Balanced Scorecard

Area of Science:

• Nephrology
• Healthcare Quality Measurement
• Health Policy

Background:

• Federal legislation introduces a merit-based incentive payment system for physicians, impacting healthcare quality assessment.
• The Centers for Medicare and Medicaid Services (CMS) currently use clinical performance measures for public reporting and payment to dialysis facilities.
• Existing nephrology performance measures often focus on processes and intermediate outcomes, potentially limiting individualized patient care.

Purpose of the Study:

• To evaluate the components of a balanced scorecard for assessing quality of care in nephrology.
• To highlight the need for incorporating patient-centered metrics alongside traditional clinical performance measures.
• To inform the development of future merit-based incentive payment systems.

Main Methods:

• Review of current clinical performance measures used by CMS in nephrology.
• Analysis of the role of patient perception surveys, such as the In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
• Conceptual framework development for a balanced quality scorecard.

Main Results:

• Current clinical performance measures in nephrology are primarily population-based and may not capture individual patient needs or goals.
• Patient perception surveys offer a valuable perspective on the quality of care received.
• A comprehensive quality assessment requires integrating clinical best practices, patient experiences, and personalized care objectives.

Conclusions:

• A balanced scorecard for physician quality assessment in nephrology should encompass population-based clinical practices, patient-reported experiences, and individualized patient goals.
• This multi-faceted approach is crucial for enhancing the quality of care and aligning with new federal payment initiatives.
• Future quality metrics should move beyond process measures to include patient-centered outcomes and preferences.