Quality Metrics in Dialysis: It Takes a Village

Dialysis is a specialized therapy rendered by a team of interdisciplinary professionals. Federal regulations mandate that dialysis facility staff, at minimum, include a registered nurse, physician, social worker, and dietitian. To ensure that patients on dialysis receive high-quality care, the Centers for Medicare and Medicaid Services introduced the first federally mandated pay for performance program in January 2012: the ESRD Quality Incentive Program. Quality metrics in the ESRD Quality Incentive Program have continuously evolved, necessitating greater involvement from the dialysis interdisciplinary team. In this article, we discuss the interdisciplinary nature of dialysis facility staffing and highlight the critical role of all care team members in attaining high performance on dialysis quality metrics. In the context of the coronavirus disease 2019 pandemic, we highlight recent staffing challenges and propose strategies to alleviate workforce shortages. Finally, we review 2 major trends: (1) an increased emphasis on home dialysis and (2) calls to address social determinants of health, which will require the interdisciplinary team to assume an even larger role in achieving high-quality care.