Adult Kidney Disease: Referral to Nephrologist
NQF Endorsement Status Not Endorsed
NQF ID 9999
Measure Type Process
Measure Content Last Updated 2021-06-30
Info As Of Not Available
Properties
Description Percentage of patients aged 18 years and older with a diagnosis of CKD (not receiving RRT) with an eGFR <30 and proteinuria who are referred to a nephrologist and have documentation that an appointment was made for a nephrology consultation within a 12-month period
Numerator Patients who are referred to a nephrologist AND have documentation that an appointment was made for a nephrology consultation within a 12-month period
Denominator All patients aged 18 years and older with a diagnosis of CKD* (not receiving RRT) with an eGFR < 30 and proteinuria Definitions: *For the purposes of this measure, the diagnosis of CKD can be identified in one of two ways: a diagnosis of CKD Stage 3, 4, or 5, CKD NOS, OR two eGFR lab results < 60 more than 90 days apart Proteinuria: 1. >300mg of albumin in the urine per 24 hours OR 2. ACR >300 mcg/mg creatinine OR 3. Protein to creatinine ratio > 0.3 mg/mg creatinine RRT (Renal Replacement Therapy)-For the purposes of this measure, RRT includes hemodialysis, peritoneal dialysis, and kidney transplantation
Denominator Exclusions Documentation of system reason(s) for patient not being referred to a nephrologist (eg, patient already received a nephrology consultation, other system reasons)
Rationale Frequently the primary care provider will make the diagnosis of chronic kidney disease. Referral to a nephrologist or other specialist for consultation or co- management should be made after diagnosis under the following
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Adult Kidney Disease: Referral to Nephrologist
circumstances: a clinical action plan cannot be prepared based on the stage of the disease, the prescribed evaluation of the patient cannot be carried out, or the recommended treatment cannot be carried out. These activities may not be possible either because the appropriate tools are not available or because the primary care physician does not have the time or information needed to do so. In general, patients with GFR <30 mL/min/1.73 m2 (CKD Stages 4-5) should be referred to a nephrologist. (KDOQI, 2002) Among patients beginning ESRD therapy in 2008, 43.7% had not seen a nephrologist prior to initiation of therapy1. Of those with no nephrologist care prior to initiating therapy, 89% initiated with a catheter and only 2.6% had a fistula, the preferred vascular access modality1. 47% of African American patients receive no nephrologist care before beginning ESRD therapy, compared to 41% of white patients1. In 2008, 57 percent of new ESRD patients had received some pre-ESRD nephrology care; just 25 percent received care for more than twelve months1. In a study comparing referral patterns of primary care physicians for CKD, results show that women, minorities, elderly patients, and those with non- private insurance (ie, Medicare and Medicaid) are at risk for late or non-referral to a nephrologist for CKD.37 With respect to the elderly, female gender and a higher burden of comorbidity predict non-referral
Evidence Not Available
Developer/Steward
Steward Renal Physicians Association; joint copyright with AMA PCPI
Contact Not Available
Measure Developer Not specified
Development Stage Not Available
Characteristics
Measure Type Process
Meaningful Measure Area Not Available
Report Generated: Fri Oct 01 10:23:07 EDT 2021 | Page 2
Adult Kidney Disease: Referral to Nephrologist
Healthcare Priority Promoting Effective Communication and Coordination of Care eCQM Spec Available Not Available
NQF Endorsement Status Not Endorsed
NQF ID 9999
Last NQF Update Not Available
Target Population Age 18+
Target Population Age (High) Not Available
Target Population Age (Low) 18
Reporting Level Not Available
Conditions Chronic Kidney Disease (CKD)
Subconditions Not Available
Care Settings Not Available
Groups
Core Measure Set Not Available
Measure Links
Measure Program: Physician Value-Based Payment Modifier
Info As Of Not Available
Program / Model Notes
Report Generated: Fri Oct 01 10:23:07 EDT 2021 | Page 3
Adult Kidney Disease: Referral to Nephrologist
Data Sources Electronic Clinical Data (non-EHR); Electronic Health Record; Registries; Claims Data
Purposes Not Available
Quality Domain Not Available
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links
Milestones
Milestone: Declined
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
MUC ID X-2527
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
Measure Program: Physician Compare
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Adult Kidney Disease: Referral to Nephrologist
Info As Of Not Available
Program / Model Notes
Data Sources EHR; Electronic Clinical Data (non-EHR); Registries; Claims Data
Purposes Not Available
Quality Domain Not Available
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Compare-DAC
Milestones
Milestone: Declined
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
MUC ID X-2527
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
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Adult Kidney Disease: Referral to Nephrologist
Measure Program: Medicare Shared Savings Program
Info As Of Not Available
Program / Model Notes
Data Sources Electronic Health Record; Claims Data; Electronic Clinical Data (non-EHR); Registries
Purposes Not Available
Quality Domain Not Available
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/about
Milestones
Milestone: Declined
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
MUC ID X-2527
Milestone: Reference
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Adult Kidney Disease: Referral to Nephrologist
Effective Date 1900-01-01
Comments Not Available
Measure Program: Medicare and Medicaid Electronic Health Record Incentive Program for Eligible Professionals
Info As Of Not Available
Program / Model Notes
Data Sources Claims Data; Registries; Electronic Clinical Data (non-EHR); Electronic Health Record
Purposes Not Available
Quality Domain Not specified
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links
Milestones
Milestone: Declined
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
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Adult Kidney Disease: Referral to Nephrologist
Name Value
MUC ID X-2527
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
Measure Program: Medicare Physician Quality Reporting System
Info As Of Not Available
Program / Model Notes
Data Sources Electronic Health Record; Registries; Claims Data; Electronic Clinical Data (non-EHR)
Purposes Not Available
Quality Domain Not Available
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links
Milestones
Milestone: Declined
Report Generated: Fri Oct 01 10:23:08 EDT 2021 | Page 8
Adult Kidney Disease: Referral to Nephrologist
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
MUC ID X-2527
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
Report Generated: Fri Oct 01 10:23:08 EDT 2021 | Page 9