In October 2015, the Centers for Medicare & Medicaid Services (CMS) expanded the use of its CROWNWeb data collection system by presenting the end-stage renal disease (ESRD) community with a means to capture data on clinical depression screening and pain assessment efforts.
Depression affects millions around the world, regardless of age, race, gender, or ethnic background. Furthermore, dealing with the factors that come with having stage 5 chronic kidney failure can add to renal patients’ burden. Depression is a common, under-recognized, and under-treated problem that is independently associated with increased morbidity and mortality in chronic kidney disease patients.1 Furthermore, studies have shown that pain is a significant problem for more than 50% of patients with ESRD, and up to 82% of those patients report moderate to severe chronic pain.2
CMS is interested in whether and how Medicare-certified dialysis providers perform pain assessment and clinical depression screening. To analyze these important issues, CMS incorporated “Clinical Depression Screening and Follow-Up” and “Pain Assessment and Follow-Up” as new reporting measures in the agency’s Payment Year (PY) 2018 ESRD Quality Incentive Program (ESRD QIP).
To comply with these new reporting measures, authorized facility representatives are required to use CROWNWeb to indicate, for each qualified patient, whether they conducted a pain assessment and a clinical depression screening during the performance period, and whether a patient was referred for follow-up for either of these conditions.
CROWNWeb and the ESRD QIP
Since the early developmental stages of CROWNWeb, CMS envisioned this system serving as a tool that could be used across multiple platforms to support data reporting needs. CROWNWeb serves as the ESRD patient registry and quality reporting system, and supports a multitude of CMS initiatives, including the agency’s Quality Strategy, CMS’ Three Aims for the ESRD Network Program, and the ESRD QIP. CROWNWeb has evolved over the years to include data reporting fields and functionalities that directly support ongoing changes to the ESRD QIP and facilities’ ability to meet the requirements of these programs. PY 2018 of the ESRD QIP presents the latest change to the ESRD QIP and CROWNWeb. The Clinical screen in CROWNWeb has been updated to enable users to report pain assessment and clinical depression screening data via a “Patient Reporting” tab.
Clinical Depression Screening and Follow-Up
According to CMS, nearly 30% of beneficiaries with ESRD experience significant symptoms of depression, which can lead to low energy, fatigue, sleep disturbance, and anorexia.3 Additionally, according to Paul L. Kimmel, MD, of the Division of Renal Diseases and Hypertension at George Washington University Medical Center, depression is the most common psychological disorder in patients with ESRD.4
With a focus on working toward improving outcomes in patients’ mental health and to promote person- and family-centered care, CMS adopted a depression measure for PY 2018 of the ESRD QIP that is based on National Quality Forum (NQF)-endorsed measure #0418, “Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan.”
Under the Screening for Clinical Depression and Follow-Up reporting measure, authorized facility representatives are required to use CROWNWeb annually to indicate, for each qualified patient, the outcome of a clinical depression screening and whether a follow-up plan is documented.
For PY 2018, CMS will review submitted data to analyze whether facilities screened patients for clinical depression, and whether a follow-up plan was documented.
In support of PY 2018, facility representatives must use CROWNWeb to report one of the following conditions for each eligible patient at least once between January 1, 2016 and January 31, 2017:
- Screening for clinical depression is documented as being positive, and a follow-up plan is documented
- Screening for clinical depression is documented as positive, a follow-up plan is not documented, and the facility possesses documentation stating the patient is not eligible for depression screening
- Screening for clinical depression is documented as positive, the facility possesses no documentation of a follow-up plan, and no reason is given
- Screening for clinical depression is documented as negative, and a follow-up plan is not required
- Screening for clinical depression is not documented, but the facility possesses documentation stating the patient is not eligible for depression screening
- Clinical depression screening is not documented, and no reason is given.5
Figure 1 shows the Clinical Depression Screening and Follow-Up Reporting Options in CROWNWeb.