The Next Frontier of Kidney Care Quality: Addressing Known Gaps to Transform Care Delivery

Over the past decade, quality measurement for patients with kidney disease has been centered on pay-for-performance metrics for kidney failure. From the seminal Centers for Medicare Services ESRD Quality Incentive Program in 2012 to Centers for Medicare Services dialysis start ratings in 2015 to more recent Centers for Medicare and Medicaid Innovation value-based care kidney models, like ESRD Treatment Choices and Kidney Care Choices, there has largely been a focus on care provided in dialysis units. The value of existing kidney-based quality measures has been evaluated, illustrating challenges with validity, attribution, and risk adjustment. Similarly, the current models of incentivization have been questioned with respect to meaningful impacts on improving care. In order to transform kidney care quality, the next phase of quality program development must focus on patient-centeredness, clinical outcomes, and health equity and should be applied across the continuum of kidney care delivery; incorporation of these elements is critical to ensure patients' perspectives on quality are included, longstanding disparities are addressed, and silos of CKD care are broken down. There is an opportunity to fundamentally shift kidney care quality to a new frontier and drive real improvements in care delivery.