Current through Register Vol. 24-18, September 15, 2024
For purposes of determining which of the competing
applications should be approved, the criteria in this section will be used as
the only means for comparing two or more applications to each other. No other
criteria or measures will be used in comparing two or more applications to each
other under any of the applicable subcriteria within WAC
246-310-210,
246-310-220,
246-310-230 or
246-310-240.
(1) An application will be denied if it fails
to meet any criteria under WAC
246-310-210,
246-310-220,
246-310-230, or
246-310-240 (2) or
(3).
(2) An application will be denied if the
applicant has one or more kidney disease treatment centers in the planning area
not meeting the 4.5 or 3.2 in-center patients per station standards required in
WAC 246-310-812 (5) or
(6) as of the most recent quarterly report
from the Network as of the date of the letter of intent.
(3) When available, Washington kidney disease
treatment centers must be used as comparables, as follows:
(a) For existing kidney disease treatment
centers proposing to expand, use data for the existing center plus the next two
closest Washington centers as comparables owned by or affiliated with the
applicant as measured by a straight line. Straight lines will be calculated
using "Google Maps" or equivalent mapping software (mileage calculated out to
two decimal points, no rounding).
(b) For new kidney disease treatment centers,
use data for the next three closest centers as comparables owned by or
affiliated with the applicant as measured by a straight line from the proposed
new kidney disease treatment center location. Straight lines will be calculated
using "Google Maps" or equivalent mapping software (mileage calculated out to
two decimal points, no rounding).
(c) The number of applications per concurrent
review cycle that rely on the same three comparables is limited to
two.
(d) If complete medicare data
is not available for any of the kidney disease treatment centers and a center
has been granted a department exemption in WAC
246-310-803(3),
then that center will not be used as a comparable and the next closest center
should be used as a comparable.
(e)
If the applicant currently does not own or is not affiliated with any kidney
disease treatment center, the department will assign the following points:
(i) The median quintile points for those
superiority measures using quintiles (excluding net revenue per
treatment);
(ii) Two points for
standardized mortality ratio (SMR);
(iii) Two points for standardized
hospitalization ratio (SHR); and
(iv) Any remaining points for other measures
will be based on the representations made in the application.
(f) If the applicant owns or is
affiliated with one existing kidney disease treatment center in total, the
department will assign the center's actual points as follows:
(i) The actual quintile points for those
superiority measures using quintiles;
(ii) The actual points for SMR;
(iii) The actual points for SHR;
and
(iv) Any remaining points for
other measures will be based on the representations made in the
application.
(g) If the
applicant owns or is affiliated with two existing kidney disease treatment
centers, the department will average the center's scores as follows:
(i) The average quintile points for those
superiority measures using quintiles;
(ii) The average points for SMR;
(iii) The average points for SHR;
and
(iv) The average of the
remaining points for other measures will be based on the representations made
in the applications.
(4) The following table identifies the data
measures and the data sources:
|
Data
Item |
Source |
|
Home peritoneal dialysis and home hemodialysis
training (Yes or No) |
DFC report |
|
Shift beginning after 5:00 p.m.? (Yes or
No) |
DFC report |
|
Nursing home residents percentage
(quintile) |
Dialysis facility report (DFR) |
|
Average number of comorbidities claimed
(quintile) |
Dialysis facility report (DFR) |
|
Standardized mortality ratio performance (SMR)
(better than expected, as expected, worse than expected) |
DFC report - 4 year |
|
Standardized hospitalization ratio performance
(SHR) (better than expected, as expected, worse than expected) |
DFC report - 1 year |
|
Medicare total performance score
(quintile) |
QIP report |
|
Net revenue per treatment
(quintile) |
Department calculation from medicare cost report.
Divide total revenue by total treatments. |
(5)
The department will obtain the medicare QIP total performance scores (QIP
Report) and the kidney dialysis facility compare reports (DFC Report) from the
medicare website on the first working day in February.
(6) The department will determine the
quintile scores and non-quintile scores. The department will calculate the
quintile scores using the following process for each quintile measure:
(a) For all kidney disease treatment centers
for which data is available, sort the centers from most favorable to least
favorable according to the identified data.
(b) Use the percent rank formula using Excel
to create the per-centile ranking for each kidney disease treatment center in
the data set. The array used in the formula is the data set of available center
data identified for that measure.
(c) Assign quintile and nonquintile scores
using the following methods:
(i) Quintile
measures. For nursing home resident percentage, number of comorbidities, and
QIP total performance score measures, the department will determine the
quintile scores using the following process:
(A) Kidney disease treatment centers with a
percentile ranking of 80 percent or higher get five points.
(B) Kidney disease treatment centers with a
percentile ranking less than 80 percent and greater than or equal to 60 percent
get four points.
(C) Kidney disease
treatment centers with a percentile ranking less than 60 percent and greater
than or equal to 40 percent get three points.
(D) Kidney disease treatment centers with a
percentile ranking less than 40 percent and greater than or equal to 20 percent
get two points.
(E) Kidney disease
treatment centers with a percentile ranking below 20 percent get one
point.
(ii) Quintile
measure. For the net revenue per treatment measure, the department will
determine the quintile scores using the following process:
(A) Kidney disease treatment centers with a
percentile ranking of 80 percent or higher get one point.
(B) Kidney disease treatment centers with a
percentile ranking less than 80 percent and greater than or equal to 60 percent
get two points.
(C) Kidney disease
treatment centers with a percentile ranking less than 60 percent and greater
than or equal to 40 percent get three points.
(D) Kidney disease treatment centers with a
percentile ranking less than 40 percent and greater than or equal to 20 percent
get four points.
(E) Kidney disease
treatment centers with a percentile ranking below 20 percent get five
points.
(F) Hospitals that do not
have a cost report may submit net revenue per treatment actuals from the
previous year. Hospitals must also submit a signed attestation stating the net
revenue per treatment data is accurate.
(iii) Nonquintile measures. The department
will determine the nonquintile scores using the following process:
(A) Kidney disease treatment centers that
offer training services are given one point.
(B) Kidney disease treatment centers that
offer a shift that begins after 5 p.m. are given one point.
(C) The department will determine SMR points
for kidney disease treatment centers as follows:
(I) "Better than expected" get four
points.
(II) "As expected" get two
points.
(III) "Worse than expected"
get 0 points.
(D) The
department will determine SHR points for kidney disease treatment centers as
follows:
(I) "Better than expected" get four
points.
(II) "As expected" get two
points.
(III) "Worse than expected"
get 0 points.
(E) The
department will assign two points for an "as expected" score for kidney disease
treatment centers missing only SMR data from the DFC report, provided the
center was granted an exception under WAC
246-310-803(3).
(7) The
department will publish the data set including resulting scores and quintiles
for all kidney disease treatment centers for review no later than March 15th or
the first working day thereafter. The data set, including resulting scores and
quintiles, will remain open for review and any person may propose the
correction of data to the department for seven calendar days. Correction of
data may be proposed as follows:
(a) Training
services (HPD and HHD): The department will accept a copy of a medicare
certification for training services (HPD and HHD) as evidence that a kidney
disease treatment center provides these services, regardless of what is
represented in the DFC report.
(b)
Data related to a shift beginning after 5 p.m.: The department will accept an
attestation that a center either operates a shift beginning after 5 p.m. or
will operate that shift if there is a need, regardless of what is represented
in the DFC report.
(c) The
department will publish the final data set, including resulting scores and
quintiles, no later than the first working day in April.
(8) The department will do the following
analysis in order to determine the superior application:
(a) Create the comparable kidney disease
treatment center set for each application per subsection (3) of this
section.
(b) Determine the
individual measure scores for each application by taking the simple average of
the comparable scores for each measure.
(c) Determine the total score in the
following manner according to the table below:
|
Data
Items: |
Calculation of
Points |
Score |
|
Home training |
The average score of comparable centers rounded up
to two decimal places. | |
|
Shift beginning after 5 p.m. |
The average score of comparable centers rounded up
to two decimal places. | |
|
Nursing home residents |
Average quintile score of comparable centers
rounded up to two decimal places. | |
|
Average number of comorbid
conditions |
Average quintile score of comparable centers
multiplied by 1.25 and rounded up to two decimal places. | |
|
Standardized mortality ratio |
Average score of comparable centers rounded up to
two decimal places. | |
|
Standardized hospitalization ratio |
Average score of comparable centers rounded up to
two decimal places. | |
|
QIP total performance score |
Average quintile score of comparable centers
multiplied by 2.0 and rounded up to two decimal places. | |
|
Net revenue per treatment |
Average quintile score of comparable centers
rounded down to two decimal places. | |
|
Total score |
Sum each of these individual average scores to
arrive at total score. | |
(9) The application with the highest total
score will be the superior alternative for the purpose of meeting WAC
246-310-240(1).
(10) After applying the superiority criterion
in this section, if applications are tied, the department will use the
following process to determine the superior alternative:
(a) An applicant that was assigned points
under subsection (3)(e) of this section in the superiority analysis will be
considered the superior alternative; if no applicant was assigned points under
subsection (3)(e) of this section, apply (b) of this subsection:
(b) The applicant with the highest average
QIP total performance score will be considered the superior
alternative;
(c) If applications
have the same average QIP total performance score, the applicant with the
lowest average net revenue per treatment will be considered the superior
alternative.
