The
Centers for Medicare & Medicaid Services (CMS) has issued a final
rule for 2013 that updates Medicare policies and payment rates for
dialysis facilities paid under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). CMS estimated a 4.6 percent growth in fee-for-service Medicare dialysis beneficiary enrollment between 2012 and 2013.
In August 2012, CMS released an analysis of patient claims in the new ESRD prospective payment system, which showed that this payment system has had no negative effects on patients’ health.
The ESRD PPS,
first implemented in 2011, expands renal dialysis services included in
the single bundled payment to the dialysis facilities and provides for
patient case-mix adjustments, facility level adjustments, and outlier
payments. It is intended to improve efficiency.
CY
2013 will be the third year of a four-year transition to the new
payment system. The overall impact of the CY 2013 changes is projected
to be a 3.0 percent increase in payments. Hospital-based ESRD
facilities have an estimated 3.6 percent increase in payments compared
with freestanding facilities with an estimated 2.9 percent increase.
Urban facilities are expected to receive an estimated payment increase
of 3.0 percent compared to an estimated 2.9 percent increase for rural
facilities.
The ESRD QIP
aims to promote continued improvement in the quality of care provided
to patients with ESRD. The final rule focuses on clinical measures and
has added the following QIP reporting measures to cover a broader range
of patients who receive dialysis care:
- To evaluate anemia management
Anemia Management, a reporting measure.
- To evaluate dialysis adequacy
A clinical Kt/V measure for adult hemodialysis patients.
A clinical Kt/V measure for adult peritoneal dialysis patients.
A clinical Kt/V measure for pediatric in-center hemodialysis patients.
The overall economic impact of the ESRD QIP is an estimated $24.6 million for PY 2015. The total expected payment reductions will be approximately $12.1 million, and the costs associated with the collection of information requirements for certain measures to be approximately $12.4 million.
The
estimated payment reduction will continue to incentivize facilities to
provide higher quality care to beneficiaries. The reporting measures
that result in costs associated with the collection of information are
critical to better understanding the quality of care beneficiaries
receive, particularly a patient's experience of care, and will be used
to incentivize improvements in the quality of care provided.
For more information on the final rule, see:
For more information about the ESRD PPS and ESRD QIP, please see:
https://www.cms.gov/Center/Special-Topic/End-Stage-Renal-Disease-ESRD-Center.html
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