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 Report Generated: Fri Oct 01 10:23:07 EDT 2021 | Page 1 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 Report Generated: Fri Oct 01 10:23:08 EDT 2021 | Page 4 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 Report Generated: Fri Oct 01 10:23:08 EDT 2021 | Page 5 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 Report Generated: Fri Oct 01 10:23:08 EDT 2021 | Page 6 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 Report Generated: Fri Oct 01 10:23:08 EDT 2021 | Page 7 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.