Challenge
To facilitate quality reporting, data exchange, and communication between the Centers for Medicare & Medicaid Services (CMS) and the dialysis facilities, the CMS needs a simplified system easy to use that provides real-time data exchange and analytics to care providers and other users.
Solution
eSimplicity engineers help the CMS redesign and consolidate three legacy systems into a single End-Stage Renal Disease Quality Reporting (EQRS) system. This redesigned system supports both the renal operations and the quality incentive payment.
Outcomes
The new EQRS helps elevate the user experience, lowers the burden for dialysis facilities when interacting with the CMS, and enables the agency to scale or implement new legislation as needed. Medicare-certified dialysis facilities can register, securely submit administrative and clinical data, and perform analysis in near real time.
Data Lake Made Simple. End-Stage Renal Disease (ESRD) is that stage of renal impairment that appears irreversible and permanent, and requires a regular course of dialysis or a kidney transplant to maintain life. The ESRD Conditions for Coverage (CfCs) sets baseline standards for ESRD facilities to meet when furnishing dialysis services which apply to all patients receiving care from the Medicare approved facility, not just those who are Medicare beneficiaries. All dialysis patients must receive care that meets or exceeds the CfCs. Working with our partners, eSimplicity maintains the existing systems while redesigning the whole new solution as a Data Lake with structured and unstructured data. The redesigned system is cloud-agnostic with the modern open source stack.
Areas of Expertise
Measure Calculator and Validation
CMS pays for the treatment of ESRD patients by linking a portion of payment directly to facilities’ performance on quality care measures. These measures are governed by the Final Rule for the payment year. Currently there are three clinical measures: one measure relates to anemia management and addresses hemoglobin levels; another measure relates to the success of dialysis treatment in removing waste products from patients’ blood (known as the Urea Reduction Ratio (URR)); and the last measure evaluates facilities based on the type of vascular access used to treat patients. eSimplicity data science team develops a modern measure engine and works with other CMS statistician contractors to validate the measures and calculation.
Dialysis Facility Compare
Our data science engineers generate the reports for CMS to publicly display facility ESRD quality incentive program (QIP) scores. Patients and caregivers can view these scores online on Dialysis Facility Compare. In addition, each facility is required to display a Performance Score Certificate that lists its Total Performance Score, as well as its performance on each of the quality measures identified for that year.
Technology
The system ingests structured and unstructured claims, clinical and quality measures data from multiple data source with large claims data. The system loads and extracts data to relational database systems and Big Data analytics platform. Our team enhances, centralizes core functionality, and reduces the total cost of ownership using a cloud-agnostic modern open source stack including microservices, Spark, and Docker with the support of DevSecOps tools. The EQRS microservices allow participants to register, submit quality measure data, and view their feedback reports via modular, reusable services. We create the Data Authorization Model and implement Access Control Lists (ACLs) using Sentry ACL and Kafka to limit access to sensitive business, technical data, metadata.