Specifications for the Clinical Performance Measures and the Dialysis Facility Compare Measures
Arbor Research Collaborative for Health, in collaboration with the University of Michigan Kidney and Epidemiology Cost Center (UM-KECC), develop, maintain, and update the End Stage Renal Disease (ESRD) Quality Measures for the Centers for Medicare and Medicaid Services (CMS), under the ESRD Measures Support Work contract with CMS. These include the Clinical Performance Measures (CPM) and the Dialysis Facility Compare (DFC) Measures. In addition, Arbor Research and UM-KECC work with CMS’s Measures Management System (MMS) in the development, evaluation, and reporting of the current ESRD Quality Measures.

New measures, as well as those that are revised, go through the National Quality Forum (NQF) consensus endorsement process. Once measures are in use, CMS requires that they periodically be reevaluated. This is to determine, for example, whether revisions are necessary in response to new clinical evidence, or a change in clinical guidelines since the last cycle of review. The last cycle of measure development occurred in 2007. In the summer of 2008, the specifications for the ESRD Quality Measures were formally documented with the MMS through collaboration with another CMS contractor, the Health Services Advisory Group, Inc. (HSAG). Documentation forms with the detailed measure specifications were completed for each ESRD measure (listed below), and were prepared by Arbor Research and UM-KECC.

Clinical Performance Measures (CPM)
Since February 1, 2009, these CPMs are included in Phase 1 of CROWNWeb.

Anemia Management

• CPM I a: Hemoglobin Control for ESA Therapy
• CPM I b: Monitoring Hemoglobin Levels below Target Minimum
• CPM II a: Assessment of Iron Stores

Hemodialysis (HD) Adequacy

• CPM I: Monthly Measurement of Delivered Hemodialysis Dose
• CPM II: Method of Measurement of Delivered Hemodialysis Dose
• CPM III: Minimum Delivered Hemodialysis Dose for ESRD Hemodialysis Patients Undergoing Dialytic Treatment for a Period of 6 Months or Greater
• CPM III: Minimum Delivered Hemodialysis Dose for ESRD Hemodialysis Patients Undergoing Dialytic Treatment for a Period of 90 Days or Greater

Peritoneal Dialysis (PD) Adequacy

• CPM I: Measurement of Total Solute Clearance at Regular Intervals.
• CPM II: Calculate Weekly Kt/V Urea in a Standard Way
• CPM III: Delivered Dose of Peritoneal Dialysis

Mineral Metabolism

• Measurement of Serum Calcium Concentration
• Measurement of Serum Phosphorus Concentration

Vascular Access

• CPM I: Maximizing Placement of AV Fistulae (AVF)
• CPM II: Minimizing Use of Catheters as Chronic Dialysis Access

Dialysis Facility Compare (DFC) Measures
These measures are reported on CMS’s Dialysis Facility Compare website.

Hemodialysis (HD) Adequacy, Facility Level

• Percentage of the Facility’s Hemodialysis Patients with a Urea Reduction Ratio (URR) of 65% or Greater in the Calendar Year

Anemia Management, Facility Level

• Percentage of Patients with Hemoglobin <10%
  
• Percentage of Patients with Hemoglobin >12%

Patient Survival, Facility Level

• Facility Patient Survival Classification, based on Standard Mortality Ratio (SMR)