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Facility Level Percentage of Chronic Hyperphosphatemia in Dialysis Patients

CBE ID
4650
Endorsement Status
1.0 New or Maintenance
Is Under Review
Yes
Next Maintenance Cycle
Fall 2024
1.6 Measure Description

Percentage of adult dialysis patients with a 6-month rolling average phosphorus value greater than or equal to 6.5 mg/dL.  

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
No
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9 Care Setting
1.9b Other Care Setting
Dialysis Facility
1.10 Measure Rationale

The hyperphosphatemia measure was developed based on the recommendations of a clinical TEP’s consideration of the multiple large, risk-adjusted observational studies demonstrating a consistent relationship between presence of hyperphosphatemia and adverse patient outcomes including cardiovascular complications, bone fracture, and increase mortality.  In addition, prospective studies have reported lower mortality in patients treated with improved phosphorus control or who used phosphate-binding medications. Currently dialysis facilities report whether a phosphorus level was obtained on a monthly basis, but are not evaluated on how well phosphorus levels are controlled.  This measure will help facilities identify patients with chronic elevation in phosphorus that may need additional intervention such as nutritional counseling, phosphorus binding medications or adjustment of dialysis prescription.  Improvements in the proportion of patients with a chronically elevated phosphorus should help to decrease cardiovascular complications, hospitalizations, and overall mortality. 

1.20 Types of Data Sources
1.20a Other Data Source
ESRD Quality Reporting System (EQRS): national registry of dialysis patients with mandatory participation from all Medicare-certified dialysis facilities
1.25 Data Source Details

Phosphorus values are sourced from EQRS, a mandatory reporting mechanism for all CMS-certified dialysis facilities. 

 

Data for patient placement are derived from an extensive national ESRD patient database, which is primarily based on the Renal Management Information System (REMIS), EQRS facility-reported clinical and administrative data (including CMS-2728 Medical Evidence Form, CMS-2746 Death Notification Form, and CMS-2744 Annual Facility Survey Form and patient tracking data), the Medicare Enrollment Database (EDB), and Medicare dialysis claims data (primarily outpatient). In addition, the database includes transplant data from the Scientific Registry of Transplant Recipients (SRTR), and data from the Nursing Home Minimum Dataset, the Quality Improvement Evaluation System (QIES) Business Intelligence Center (QBIC) (which includes Provider and Survey and Certification data from Automated Survey Processing Environment (ASPEN)), and the Dialysis Facility Care Compare.