The Quality Incentive Program and Patient-Centered Dialysis Care: Mastering the Numbers

In 2008, the Medicare Improvement for Patients and Providers Act required Centers for Medicare and Medicaid Services (CMS) to create the End-Stage Renal Disease Quality Incentive Program (QIP), CMS's first value-based program. Since its implementation in 2012, the QIP has tied a small percentage of Medicare reimbursement to the quality of care within dialysis facilities, ascertained using quality metrics. The scope of the QIP has shifted in the last decade from counterbalancing financial incentives for underutilization in a capitated payment system toward aligning dialysis organizations in the pursuit of CMS's broader health-related goals and objectives. In this review, we apply the Quintuple Aim framework to appraise the QIP and highlight its successes and prominent criticisms. We argue that, though QIP measures identify low-performing dialysis facilities, the program struggles to improve outcomes for people receiving dialysis, particularly individuals with greater health-related social needs. We conclude with specific recommendations for future iterations of the QIP.