Title 42

SECTION 512.370

512.370 Benchmarking and scoring.

§ 512.370 Benchmarking and scoring.

(a) General. (1) CMS assesses the home dialysis rate and transplant rate for each ETC Participant against the applicable benchmarks to calculate an -

(i) Achievement score, as described in paragraph (b) of this section; and

(ii) Improvement score, as described in paragraph (c) of this section.

(2)(i) CMS calculates the ETC Participant's MPS as the weighted sum of the higher of the achievement score or the improvement score for the ETC Participant's home dialysis rate and transplant rate, as described in paragraph (d) of this section.

(ii) The ETC Participant's MPS determines the ETC Participant's PPA, as described in § 512.380.

(b) Achievement scoring. CMS assesses ETC Participant performance at the aggregation group level on the home dialysis rate and transplant rate against benchmarks constructed based on the home dialysis rate and transplant rate among aggregation groups of ESRD facilities and Managing Clinicians located in Comparison Geographic Areas during the Benchmark Year. CMS uses the following scoring methodology to assess an ETC Participant's achievement score.

(1) 90th+ Percentile of benchmark rates for comparison geographic areas during the benchmark year: 2 points.

(2) 75th+ Percentile of benchmark rates for comparison geographic areas during the benchmark year: 1.5 points.

(3) 50th+ Percentile of benchmark rates for comparison geographic areas during the benchmark year: 1 point.

(4) 30th+ Percentile of benchmark rates for comparison geographic areas during the benchmark year: 0.5 points.

(5) <30th Percentile of benchmark rates for comparison geographic areas during the benchmark year: 0 points.

(c) Improvement scoring. CMS assesses ETC Participant improvement on the home dialysis rate and transplant rate against benchmarks constructed based on the ETC Participant's aggregation group's historical performance on the home dialysis rate and transplant rate during the Benchmark Year. CMS uses the following scoring methodology to assess an ETC Participant's improvement score.

(1) Greater than 10 percent improvement relative to the Benchmark Year rate: 1.5 points.

(2) Greater than 5 percent improvement relative to the Benchmark Year rate: 1 point.

(3) Greater than 0 percent improvement relative to the Benchmark Year rate: 0.5 points.

(4) Less than or equal to the Benchmark Year rate: 0 points.

(d) Modality Performance Score. CMS calculates the ETC Participant's MPS as the higher of ETC Participant's achievement score or improvement score for the home dialysis rate, together with the higher of the ETC Participant's achievement score or improvement score for the transplant rate, weighted such that the ETC Participant's score for the home dialysis rate constitutes 2/3 of the MPS and the ETC Participant's score for the transplant rate constitutes 1/3 of the MPS. CMS uses the following formula to calculate the ETC Participant's MPS:

Modality Performance Score = 2 × (Higher of the home dialysis achievement or improvement score) + (Higher of the transplant achievement or improvement score)

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