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End-Stage Renal Disease (ESRD) Overview

The Centers for Medicare & Medicaid Services (CMS) established the End-Stage Renal Disease (ESRD) Quality Initiative in 2004 as part of its ongoing efforts to improve the quality of dialysis care provided to ESRD patients. This initiative supports quality improvement efforts among providers and makes available quality information that will enable patients to participate in making health care decisions.

CMS uses a variety of levers to support its Three-Part Aim and the six domains of care based on the National Quality Strategy (NQS). Those levers include:

  • Continuous quality improvement (CQI) efforts.
  • Transparency and robust public reporting.
  • Coverage and payment decisions.
  • Payment incentives.
  • Conditions for coverage.
  • Grants, demonstrations, pilots, and research.

CMS strives to ensure that all of these complex levers work in concert in order to improve the quality and cost efficiency of national dialysis care for all beneficiaries. These various levers share a common goal— the provision of cost-efficient and clinically effective patient care—and they ideally complement each other to these ends.

ESRD QIP program

The ESRD Quality Incentive Program (QIP) provides an important lever for safety, value, and quality for CMS.

The ESRD QIP promotes high-quality care by outpatient dialysis facilities treating patients with ESRD. The first of its kind in Medicare, this program changes the way CMS pays for the treatment of ESRD patients by linking a portion of payment directly to facilities’ performance on quality care measures. The ESRD QIP will reduce payments to ESRD facilities that do not meet or exceed certain performance standards.

The ESRD QIP gathers performance data about dialysis facilities from Medicare reimbursement claims, CROWNWeb, and external sources such as the Center for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN).

For detailed information about the ESRD QIP, please see

The ESRD QIP is one element in a broad CMS effort to address the quality of care provided to dialysis patients. Another important component is Dialysis Facility Compare, a Medicare service that helps beneficiaries, caregivers, and others find detailed information about Medicare-certified dialysis facilities. Individuals can compare the services and the quality of care that facilities provide; the website also has other resources for patients and family members who want to learn more about chronic kidney disease and dialysis.

For questions, contact the CMS ESRD QIP staff at

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