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QCDR NamePrimary StewardAdditional QCDRs Supporting the QCDR Measure2024 or Prior QCDR Measure ID2025 QCDR Measure IDsMeasure TitleMeasure DescriptionDenominatorNumeratorDenominator Exclusions Denominator ExceptionsNumerator ExclusionsPublished SpecialtyPublished Clinical CategoryData Source Used for the MeasureIf applicable, please enter additional information regarding the data source usedCBE ID Number High-Priority MeasureHigh-Priority Type Measure Type Includes Telehealth?Inverse MeasureProportional MeasureContinuous Variable MeasureRatio MeasureIf Continuous Variable and/or Ratio is chosen, what would be the range of the score(s)?
Number of performance rates to be calculated and submitted
Performance Rate Description(s)Overall Performance RateRisk-Adjusted Status
If risk-adjusted, indicate which score is risk-adjustedDoes this measure require the use of proprietary software, devices, etc.?MIPS Reporting OptionsCare SettingIf Multiple Care Settings selected, list Care Settings hereClinical Recommendation StatementQCDR Measure RationaleFirst Performance Year
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Renal and Vascular Outcomes Improvement Program, powered by Forward Health GroupRenal and Vascular Outcomes Improvement Program, powered by Forward Health GroupN/ARCOIR13RCOIR13Percutaneous Arteriovenous Fistula for Dialysis - Clinical Success RatePercentage of clinically successful percutaneously created arteriovenous fistulae (pAVF) for patients on maintenance hemodialysis.

Percutaneous fistula creation (HCPCS codes: G2170, G2171; CPT codes: 36836, 36837)
AND
Patients aged >= 18 years at the time of the procedure
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Patient requires maintenance hemodialysis (CPT codes: 90935, 90937, 90940)*
*Additional codes may apply

Patients with percutaneously created fistulas that were deemed ready for use and cannulated with at least 2 16-gauge needles for three consecutive dialysis treatments at prescribed blood flow rates.NonePatients not on hemodialysis.NoneInterventional Radiology; Nephrology; Interventional Nephrology; Vascular SurgerySurgical/Procedural Care - Renal; Dialysis; Interventional Radiology; VascularEHR; OtherEHR: Claims, EHR (CPOE, medications, etc.); Hybrid; Record review; Survey; Other (Flat file to Excel, CCDA; QRDA file), Other: Claims, EHR (CPOE, medications, etc.); Hybrid; Record review; Survey; Other (Flat file to Excel, CCDA; QRDA file)N/AYesOutcomeOutcomeNoNoYesNoNoN/A1N/A1st Performance RateNoN/ANoTraditional MIPSOutpatient ServicesN/AUse of an arteriovenous fistula (AVF) is the preferred access for hemodialysis patients. Patients who receive dialysis via fistulas have a lower rate of infection, thrombosis and mortality than patients using grafts or catheters. Early evidence suggests that percutaneous fistula creation is less invasive, shorter in duration, and has fewer procedural complications compared with traditional open surgical procedures. Patients can often use the fistula sooner than a surgically created fistula, providing an opportunity to reduce the use of temporary catheters for dialysis.

References
Lok CE, Rajan DK, Clement J et al. Endovascular Proximal Forearm Arteriovenous Fistula for Hemodialysis Access: Results of the Prospective, Multicenter Novel Endovascular Access Trial (NEAT). Am J Kidney Dis. 2017;70(4):486-497.

Choinski KN, Sundick SA, Rao AG et al. The current role of the percutaneous arteriovenous fistula for hemodialysis access. Surg Technol Int. 2020 Nov 28;37:217-224.

Lok CE, Huber TS, Lee T, et al; KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4)(suppl 2):S1-S164.

Mallios A, Bourquelot P, Granco G et al. Midterm results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System, technical recommendations, and an algorithm for maintenance. J Vasc Surg. 2020;72(6):2097-2106.

Wasse H. Place of Percutaneous Fistula Devices in Contemporary Management of Vascular Access. Clin J Am Soc Nephrol. 2019 Jun 7;14(6):938-940.		This measure was developed in consultation with interventional nephrologists and vascular surgeons and is appropriate for their scope of specialty practice. Percutaneous fistula creation is a new technology that has the potential to yield positive results for patients needing maintenance hemodialysis. While early studies suggest high levels of success with percutaneous fistula creation, it is critically important to evaluate any new technology, track clinician performance and establish benchmarks as clinicians gain experience with the technique. This measure evaluates success of percutaneous fistula creation in the context of a clinically meaningful outcome. Cannulation of the fistula with at least two 16-gauge needles for three consecutive dialysis treatments while achieving prescribed blood flow rates is a well-established measure for successful fistulae and represents clinically meaningful results for hemodialysis patients. Defining success according to blood flow rate prescribed for the individual patient rather than focusing on specific metabolic targets accommodates the clinical status and requirements of each patient. This is an important quality measure for vascular surgeons and nephrologists, and does not duplicate any existing measure. Additionally, despite the advantages of faster maturation, success rates are still relatively low for some clinicians, reinforcing the value of the quality measure in promoting performance improvement to provide better patient outcomes.

This measure has been used since performance year 2021, with initial use of the measure relatively low because only a handful of clinicians were trained in the procedure at that time. In the subsequent years, use of the measure has increased as more clinicians become trained in the procedure. Year to date (7 months) percutaneous fistula creation has been performed on 282 patients. Data demonstrate a maturation time of up to 3 months (mean 2 months) for the percutaneously created fistula compared with maturation time of up to 8 months and a mean of 4 months for surgically created fistulas. However, despite the advantages of faster maturation, success rates are still relatively low for some clinicians, reinforcing the value of the quality measure in promoting performance improvement to provide better patient outcomes. Current success rates among clinicians and groups vary from 17% to 46%, with success being defined as use of the fistula for at least 3 dialysis treatments after maturation.		2021
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Renal and Vascular Outcomes Improvement Program, powered by Forward Health GroupRenal and Vascular Outcomes Improvement Program, powered by Forward Health GroupN/ARCOIR12RCOIR12Tunneled Hemodialysis Catheter Clinical Success RatePercentage of tunneled central venous access catheter insertions or replacements that resulted in successful dialysis treatment in patients with end-stage renal disease (ESRD).Office-based or ambulatory surgical center insertion of a tunneled central venous access device or replacement of a central venous access device during the measurement period (CPT: 36558, 36561, 36563, 36565, 36566, 36578, 36581, 36582, 36583)*
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Patients aged >=18 years at the beginning of the measurement period
AND
Requires maintenance dialysis (CPT: 90935, 90937, 90940)*
*Additional codes may apply		Patients who received full dialysis treatment as prescribed within 72 hours of catheter placement or exchange.NoneNoneNoneNephrology; Vascular Surgery; Interventional RadiologySurgical/Procedural Care - Renal; Dialysis; Interventional Radiology; VascularEHR; OtherEHR: Claims, EHR (CPOE, medications, etc.); Hybrid; Record review; Survey; Other (Flat file to Excel, CCDA, QRDA file), Patient Record, Other: Claims, EHR (CPOE, medications, etc.); Hybrid; Record review; Survey; Other (Flat file to Excel, CCDA, QRDA file)N/AYesOutcomeOutcomeNoNoYesNoNoN/A1N/A1st Performance RateNoN/ANoTraditional MIPSOutpatient ServicesN/AAlthough arteriovenous fistulas and grafts are usually considered the optimal method of vascular access for hemodialysis, central venous access catheters provide a rapid method of allowing hemodialysis in patients who may not be suitable candidates for a fistula or graft. However, because catheters are subject to thrombosis and infection, use of appropriate technique for site selection, tunneling, and catheter insertion is critical for increasing success rates, reducing time to adequate hemodialysis, and maintaining the long-term viability of the access site. The NKF-KDOQI has developed recommendations for placement of tunneled catheters under either ultrasound or fluoroscopic guidance.

References
Lok CE, Huber TS, Lee T, et al; KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4)(suppl 2):S1-S164.

Yaxley J. Tunneled Hemodialysis Catheter Insertion: Technical and Clinical Considerations. Indian J Radiol Imaging. 2022 Dec 7;33(1):76-79.		This measure was developed in consultation with interventional nephrologists and vascular surgeons and is appropriate for their scope of specialty practice. When a central venous access catheter is required for maintenance dialysis, time is of the essence - the catheter needs to be operational and functional as quickly as possible and should be tunneled to reduce complications. This measure evaluates whether a tunneled central venous catheter has been successfully placed (or replaced) and ready for use within 72 hours after placement. Catheters that are available for use more quickly will result in fewer missed dialysis treatments or need for a temporary catheter. This is an important quality measure for vascular surgeons and nephrologists, and does not duplicate any existing measure. Additionally, performance data collected to date demonstrates a wide range of success rates and therefore the measure addresses a clear performance gap across clinicians.
This measure has been used successfully for the past 5 years to evaluate performance related to placement and management of tunneled central venous catheters for dialysis. A random sample audit at the patient level (n=85) was performed to validate the individual measure elements, yielding 100% concordance between measure results and EMR data. From a total of 9706 patients, the overall success rate was 85% as of July 2024. However, success rates varied widely across clinicians and groups, ranging from 55% to 96%, supporting the assertion that a substantial performance gap still exists.		2019
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Renal and Vascular Outcomes Improvement Program, powered by Forward Health GroupRenal and Vascular Outcomes Improvement Program, powered by Forward Health GroupN/ARPAQIR15RPAQIR15Arteriovenous Fistulae Thrombectomy Clinical Success RatePercentage of clinically successful arteriovenous fistulae (AVF) thrombectomies for patients on maintenance hemodialysis.AVF thrombectomies by an interventional nephrologist, interventional radiologist, or vascular surgeon within the measurement period (CPT: 36831, 36904, 36905, 36906, 36907, 36908, 90999)*
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Patients aged 18 years and older at the beginning of the measurement period
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Diagnosis of end-stage renal disease (ESRD) (10-CM code: N18.6)
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Requires maintenance dialysis (CPT: 90935, 90937, 90940)*
*Additional codes may apply.		AVF thrombectomies for which the procedure was clinically successful. Clinical success is defined as able to dialyze successfully once with 2 needles using that access at the first dialysis treatment following thrombectomy.NoneProcedure was for AVG thrombectomyNoneNephrology; Interventional Nephrology; Interventional Radiology; Vascular SurgerySurgical/Procedural Care - Renal; Dialysis; Interventional Radiology; VascularEHR; OtherEHR: EHR (CPOE, medications, etc.); Hybrid; Record review; Survey; Other (Flat file to Excel, CCDA, QRDA file), Other: EHR (CPOE, medications, etc.); Hybrid; Record review; Survey; Other (Flat file to Excel, CCDA, QRDA file)N/AYesOutcomeOutcomeNoNoYesNoNoN/A1N/A1st Performance RateNoN/ANoTraditional MIPSOutpatient ServicesN/AAn arteriovenous fistula (AVF) provides rapid extracorporeal blood flow that is necessary for hemodialysis. An AVF is created by connecting an artery and a vein using an open surgical approach or an endovascular technique that uses heat or radiofrequency energy to create the vascular connection. Clinical guidelines indicate that early detection of AV thrombosis is critical, followed by timely interventions. The management of AVF thrombosis should be based on the clinician's experience and best judgement and may include balloon angioplasty, self-expanding stent-grafts, or surgical treatment. The approach used should consider the patient's individual circumstances and clinician's experience and expertise.

Reference
Lok CE, Huber TS, Lee T, et al; KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4)(suppl 2):S1-S164.		This measure was developed in consultation with interventional nephrologists and vascular surgeons and is appropriate for their scope of specialty practice. Arteriovenous fistulas (AVFs) can provide rapid extracorporeal blood flow that is necessary for hemodialysis and when feasible, are the preferred type of vascular access for chronic hemodialysis. However, vascular stenosis is common and can lead to inadequate hemodialysis or fistula thrombosis if not quickly identified and treated. Successful removal of a thrombosis supports continued use of the fistula, reducing the need for patients to undergo additional vascular access procedures and allowing adequate dialysis to be performed. A number of studies suggest that timely thrombectomy can offer favorable short- and long-term success in salvaging a thrombosed AVF. This measure allows evaluation of success in AVF thrombectomy using a clinically relevant outcome of dialysis success. This is an important quality measure for vascular surgeons and nephrologists, and does not duplicate any existing measure. Although the mean performance across clinicians was relatively high at 86%, success rates among clinicians ranged from 0 to 100%, indicating a significant performance gap for this procedure.2016
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Renal and Vascular Outcomes Improvement Program, powered by Forward Health GroupRenal and Vascular Outcomes Improvement Program, powered by Forward Health GroupN/ARPAQIR14RPAQIR14Arteriovenous Graft Thrombectomy Clinical Success RatePercentage of clinically successful arteriovenous graft (AVG) thrombectomies for patients on maintenance hemodialysis.AVG thrombectomies by an interventional nephrologist, interventional radiologist, or vascular surgeon within the measurement period (CPT: 36831, 36904, 36905, 36906, 36907, 36908, 90999).*
AND
Patients aged 18 years and older at the beginning of the measurement period
AND
Diagnosis of end-stage renal disease (ESRD) (ICD-10-CM: N18.6)
AND
Requires maintenance dialysis (CPT: 90935, 90937, 90940)*
*Additional codes may apply.		AVG thrombectomies for which the procedure was clinically successful. Clinical success is defined as able to dialyze successfully once with 2 needles using that access at the first dialysis treatment following thrombectomy.NoneProcedure was for AVF thrombectomyNoneNephrology; Interventional Nephrology; Interventional Radiology; Vascular SurgerySurgical/Procedural Care - Renal; Dialysis; Interventional Radiology; VascularEHR; OtherEHR: EHR (CPOE, medications, etc.); Hybrid; Record review; Survey; Other (Flat file to Excel, CCDA, QRDA file), Other: EHR (CPOE, medications, etc.); Hybrid; Record review; Survey; Other (Flat file to Excel, CCDA, QRDA file)N/AYesOutcomeOutcomeNoNoYesNoNoN/A1N/A1st Performance RateNoN/ANoTraditional MIPSOutpatient ServicesN/AAn arteriovenous graft (AVG) provides rapid extracorporeal blood flow that is necessary for hemodialysis. An AVG consists of synthetic tube implanted under the skin, connecting between the artery and the vein, and providing needle placement access for dialysis. Clinical guidelines indicate that early detection of AV lesions is critical, followed by timely interventions. The management of AVG thrombosis should be based on the clinician's experience and best judgement and may include balloon angioplasty, self-expanding stent-grafts, or surgical treatment. The approach used should consider the patient's individual circumstances and clinician's experience and expertise.

References
Lok CE, Huber TS, Lee T, et al; KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4)(suppl 2):S1-S164.		This measure was developed in consultation with interventional nephrologists and vascular surgeons and is appropriate for their scope of specialty practice. Arteriovenous grafts (AVGs) can provide rapid extracorporeal blood flow that is necessary for hemodialysis. However, vascular stenosis is common and can lead to inadequate hemodialysis or graft thrombosis if not quickly identified and treated. Successful removal of a thrombosis supports continued use of the AVG, reducing the need for patients to undergo additional vascular access procedures and allowing adequate dialysis to be performed. A number of studies suggest that timely thrombectomy can offer favorable short- and long-term success in salvaging a thrombosed AVG. This measure allows evaluation of success in AVG thrombectomy using a clinically relevant outcome of dialysis success. This is an important quality measure for vascular surgeons and nephrologists, and does not duplicate any existing measure. Although the mean performance across clinicians is relatively high for this measure (87%), there remains considerable range in success rates (33% to 100%) at the individual clinician level, and therefore this measure addresses a substantial performance gap for this procedure.2016
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