MINUTES
Kidney Care Quality Initiative Pay for Performance Work Group
December 2, 2005
Conference Call

Attendees:
Alan Nissenson, Facilitator Leader
Ray Hakim
Jonathan Himmelfarb
Don Wesson
LeAnne Zumwalt
Kathy Lester, Patton Boggs and Kidney Care Partners

Not in Attendance:
Brian Pereira

Summary
The Kidney Care Quality Initiative (KCQI) Pay for Performance Work Group discussed the funding mechanism, incentive structure, reporting, implementation, and evaluation of the program in crafting a pay for performance system. A narrative document will be drafted to reflect the group's consensus on the structure of a pay for performance system.

Discussion of Steering Committee Guiding Principles
The group agreed that the Steering Committee should clearly express that traditional methods of payment in other areas are inappropriate because of the lack of an annual update mechanism and other problems with the reimbursement policy.

The Work Group also agreed that the guidelines should specify facilities and providers, rather than suggest a focus on facilities only. Some members of the group expressed concern that the principles overemphasized updating the composite rate.

Discussion of Crafting the P4P Structure Funding Mechanism
The group agreed that the pay for performance system should be a continuum of efforts. An update will be mentioned as a part of this process, though the concepts will not be overtly linked. Any recommendation will address the issue regarding the source of new money, otherwise Congress will structure the system as a withhold model. Fixing the update and SGR, and moving the system toward a gain-sharing model will generate new money.

Incentive Structure
The group decided that a composite score is the most appropriate way to measure improvement. The group cited cherry picking and the potential disadvantage to rural, urban, and small providers if metrics are not measured using a composite score. To reach consensus on the benchmark issue, the group recommended creation of an ESRD and a CKD committee to work with CMS to develop targets.

The work group agreed that payments should be as frequent as possible and occur no later than three months after reporting.

Reporting
The group reached a consensus that the Health and Human Services Secretary should review any data reporting system and minimize duplication.

Implementation
Ms. Lester clarified a recommendation that allows CMS to delay full implementation if data is unavailable. However, payment for reporting would continue even if full implementation were delayed.

Evaluation Program
The group discussed whether MedPAC is the appropriate group to evaluate a Pay for Performance program. Ms. Lester shared that MedPAC, as an outside agency, has the ability to meet deadlines and engage knowledgeable staff. IOM can conduct a similar evaluation with an allocation of $1 million.

The group agreed that MedPAC should annually evaluate the program, and after two years, both MedPAC and IOM should evaluate the pay for performance system. The work group agreed that a team to help low performers improve is necessary. Tying networks into assisting low performers is a possibility.

Next Steps
Ms. Lester will draft a narrative document reflecting the group's recommendations to circulate to the work group. Another call may be scheduled to review member comments on the draft documents.