The purpose of the Centers for Medicare & Medicaid Services (CMS) End-Stage Renal Disease (ESRD ) Quality Incentive Program (QIP) is to improve patient care by setting performance standards for quality of care. Facilities failing to meet performance standards may be subject to a payment reduction of up to 2%. The ESRD QIP was established by Congress under the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA) and is administered by CMS. The ESRD QIP uses a point system for clinical measures and reporting measures which add up to a facility’s “Total Performance Score” which is shared with the public.