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Disclosures: Regnier is president of the Renal Healthcare Association.
September 15, 2021
3 min read

Administrators ask CMS to limit accountability on vaccinations in proposed rule


Disclosures: Regnier is president of the Renal Healthcare Association.
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Dialysis facilities “should not be accountable” for patient and staff decisions for getting vaccinated, but information on who is not vaccinated should be disseminated to the public, the Renal Healthcare Association said in a letter to CMS.

“There are many individuals who have elected to not get vaccinated, are hesitant or otherwise cannot receive the vaccine for medical reasons,” Maria Regnier, RN, MSN, CNN, Renal Healthcare Association (RHA) president, wrote in comments on the proposed rule for the Prospective Payment System. The final rule will become effective in January.

Maria Regnier

“Whether or not an individual decided to get vaccinated is completely outside of the control of a facility and, as such, facilities should not be accountable” for those decisions, she wrote.

The RHA said CMS should track and disseminate information on patients on dialysis and staff who are vaccinated and make that information available to the public, particularly for patients and families deciding on a dialysis clinic.

“The RHA supports tracking and reporting COVID-19 vaccination rates for [end-stage renal disease] ESRD patients and health care personnel at individual dialysis facilities, as we agree with CMS that having such information will better enable patients and their families to make treatment decisions that meet their individual care needs,” Regnier wrote. “The RHA supports presenting COVID-19 vaccination rates for ESRD patients and dialysis facility health care personnel at individual facilities on dialysis facility care (DFC).”

QIP measures

However, Regnier wrote, the RHA does not support two measures CMS is considering for the Quality Incentive Program (QIP) next year that could penalize dialysis providers based on the number of patients and staff who are not vaccinated.

“The RHA strongly does not support adding either measure under consideration – the COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure or the COVID-19 Vaccination Coverage for Patients in ESRD Facilities measure – to the ESRD QIP.

While we believe it is important for patients and families to know vaccination rates, the RHA strongly feels it is not appropriate to hold facilities accountable in the QIP for either patients or health care personnel receiving vaccines ... [F]acilities should not be accountable – and potentially be subject to payment cuts – in the QIP for both COVID-19 vaccination measures under consideration,” she wrote.

ETC model

In other comments on the proposed rule, the RHA said dialysis providers participating in the ESRD Treatment Choices (ETC) model need more options to meet goals set by CMS for increasing the number of patients on home dialysis.

In the proposed rule, CMS said it would allow smaller dialysis providers with in-center nocturnal programs to take partial credit for those patients as part of a home dialysis census in the mandated ETC model.

While the RHA said it supports the measure, it said in its comments on the proposed rule that CMS did not go far enough.

“The RHA strongly appreciates and thanks CMS for its recognition that small and independent dialysis facilities face significant challenges in achieving success in the ETC model due to resource limitations that make it difficult to develop and maintain home dialysis programs,” Regnier wrote. “We therefore support allowing non-[large dialysis organizations] LDOs to receive credit in the home dialysis rate for nocturnal incenter dialysis and also respectfully request that non-LDOs receive full credit in the home dialysis rate for referring patients to clinics with active home dialysis programs.”

However, Regnier added: “The RHA continues to have significant concerns that making the costly and time-consuming structural changes to care practices necessary for successful participation in the ETC model is beyond what can reasonably be expected from dialysis facilities during the ongoing COVID-19 public health crisis – particularly for non-LDOs often times treating patients in rural and underserved communities. We also remain extremely concerned that the ETC model could severely jeopardize patient access to treatment, as well as lead to further consolidation in the already highly concentrated dialysis market.”

The RHA did say in the letter it was supportive of a proposal that would allow managing clinicians in the ETC model to furnish kidney dialysis education (KDE) services via telehealth and reduce or waive beneficiary coinsurance for KDE services when cost presents barriers in access to care.