Payment for quality in end-stage renal disease.

The Centers for Medicare and Medicaid Services (CMS) EndStage Renal Disease (ESRD) Program has served as a model for health care policy innovation because of several unique features: the program provides dialysis and kidney transplantation services where the alternative to renal replacement therapy is death; the program has a circumscribed, easily tracked population of patients; and the cost associated with the program has afforded administrators and providers opportunity for innovation and improvement in care delivery over the past three decades (1). Additionally, the wealth of detailed information available from unique databases such as the United States Renal Data System that have been designed to follow the ESRD population have facilitated assessment of the effect of evidence-based guidelines that have shaped health care delivery and policy. The recent publication of the Final Physician Fee Schedule Rule by CMS, the release of the Medicare Payment Advisory Commission (MedPAC) report on payment for out-patient dialysis, and the Medicare Modernization Act (MMA) of 2003 have focused attention on the goal of linking payments to quality care in the ESRD setting. The leadership of the American Society of Nephrology and the National Kidney Foundation recently convened a working group of experts to examine whether the ESRD system of payment can be redesigned to encourage quality-based care delivery. The deliberations of this group (Appendix) helped formulate this article.