Healio Special Report: Health Care and Politics

Healio Special Report: Health Care and Politics

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July 06, 2021
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CMS proposes increase in dialysis payment, exceptions in performance due to COVID-19

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CMS released a proposed rule in the Federal Register on July 1 that would increase the payment rate for dialysis treatments next year and make exceptions in the performance scoring for the ESRD Quality Incentive Program due to COVID-19.

In the 345-page filing, the agency proposes to increase the Medicare bundled payment rate per dialysis treatment from $253.13 to $255.55, an increase of $2.42 per treatment.

That is significantly lower than the $13.80 increase in the base rate per treatment that facilities received for 2021.

That rate increase, however, did include $9.93 to cover drug add-on payments for calcimimetics, which had previously been covered separately by CMS outside the bundled payment rate.

CMS is also proposing to update an add-on payment adjustment to the bundled payment rate for dialysis providers who use new and innovative equipment and supplies. The average per treatment offset amount for home dialysis machines would be $9.41, according to the proposed rule.

The rule also includes proposals under the ESRD Quality Incentive Program (QIP) to not score facilities or reduce payments based on four measures – hospitalization rate, patient satisfaction surveys, long-term catheter rate and hospital readmissions – in the past year because of the impact of the COVID-19 pandemic, as well as technical problems with the data reporting system that CMS requires dialysis clinics to use.

“Although ... regional differences in COVID-19 prevalence rates do not reflect differences in the quality of care furnished by dialysis facilities, they could directly affect the payment penalties that these facilities could receive and could result in an unfair and inequitable distribution of those penalties,” CMS wrote. “These inequities could be especially pronounced for dialysis facilities that have treated a large number of COVID-19 patients.”

The agency is also asking for input on a new performance measure that would incorporate COVID-19 health care provider and patient vaccination measures in the ESRD QIP measure set.

“Currently, nearly 90% of all dialysis facilities are reporting vaccination data performance to the Center for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN),” CMS said in a press release. “CMS is evaluating options for publicly reporting the data on official CMS datasets that compare the quality of care provided in Medicare-certified dialysis facilities nationwide.”

Comments are due on the proposed changes to CMS by August 31. To access the proposed rule in the Federal Register, click here.

References:
www.cms.gov/newsroom/fact-sheets/end-stage-renal-disease-esrd-prospective-payment-system-pps-calendar-year-cy-2022-proposed-rule-cms
www.federalregister.gov/public-inspection