Optimal Care for Kidney Health: Development of a Merit-based Incentive Payment System (MIPS) Value Pathway

Sri Lekha Tummalapalli, Division of Healthcare Delivery Science & Innovation and Division of Nephrology & Hypertension, Weill Cornell Medicine, New York, New York.
Sarah A. Struthers, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.
David L. White, American Society of Nephrology, Washington, DC.
Amy Beckrich, Renal Physicians Association, Rockville, Maryland.
Yasmin Brahmbhatt, AstraZeneca, Wilmington, Delaware.
Kevin F. Erickson, Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas.
Pranav S. Garimella, Division of Nephrology-Hypertension, University of California San Diego, San Diego, California.
Edward R. Gould, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee.
Nupur Gupta, Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Krista L. Lentine, Saint Louis University Transplant Center, SSM-Saint Louis University Hopstial, St. Louis, Missouri.
Susie Q. Lew, Division of Renal Diseases and Hypertension, George Washington University, Washington, DC.
Frank Liu, The Rogosin Institute, New York, New York.
Sumit Mohan, Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York.
Michael Somers, Division of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Daniel E. Weiner, Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.
Scott D. Bieber, Kootenai Health, Coeur d'Alene, Idaho.
Mallika L. Mendu, Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts.

Document Type

Journal Article

Publication Date

8-1-2023

Journal

Journal of the American Society of Nephrology : JASN

Volume

34

Issue

8

DOI

10.1681/ASN.0000000000000163

Abstract

The Merit-based Incentive Payment System (MIPS) is a mandatory pay-for-performance program through the Centers for Medicare & Medicaid Services (CMS) that aims to incentivize high-quality care, promote continuous improvement, facilitate electronic exchange of information, and lower health care costs. Previous research has highlighted several limitations of the MIPS program in assessing nephrology care delivery, including administrative complexity, limited relevance to nephrology care, and inability to compare performance across nephrology practices, emphasizing the need for a more valid and meaningful quality assessment program. This article details the iterative consensus-building process used by the American Society of Nephrology Quality Committee from May 2020 to July 2022 to develop the Optimal Care for Kidney Health MIPS Value Pathway (MVP). Two rounds of ranked-choice voting among Quality Committee members were used to select among nine quality metrics, 43 improvement activities, and three cost measures considered for inclusion in the MVP. Measure selection was iteratively refined in collaboration with the CMS MVP Development Team, and new MIPS measures were submitted through CMS's Measures Under Consideration process. The Optimal Care for Kidney Health MVP was published in the 2023 Medicare Physician Fee Schedule Final Rule and includes measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The nephrology MVP aims to streamline measure selection in MIPS and serves as a case study of collaborative policymaking between a subspecialty professional organization and national regulatory agencies.

Department

Medicine

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