The Centers for Medicare and Medicaid Services (CMS) released the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule for CY2024 and it includes high expected costs for the Medicare program, but renal disease advocacy groups are accusing the agency of underpaying standalone clinics and introducing a pay cliff.
The payments to hospital-based dialysis centers will increase 3.1% and freestanding dialysis clinics will receive a 2% raise in the final rule. Bloomberg Law notes that the total pay for the 7,900 dialysis centers across the country will total $6.7 billion, as the base payment goes from $271.02 to $265.57.
But Kidney Care Partners, which includes ESRD patient groups, dialysis providers and nurses, called the final rule a “slap in the face,” as 2.1% for standalone clinics is insufficient, Inside Health Policy reports. From John Butler, chair of Kidney Care Partners:
The final ESRD PPS rule is a ‘slap in the face’ to the nation’s kidney community, as CMS has completely failed to address concerns raised by patients, physicians, nurses and others in the kidney care community, as well as bipartisan members of Congress during the rulemaking process. By offering grossly insufficient reimbursement for vital kidney care services, care providers will continue to see crippling labor shortages and overall increased access barriers for individuals dependent on life sustaining care.
The rule also covers certain new biological products and drugs after the Transitional Drug Add-on Payment Adjustment (TDAPA) period ends. According to a CMS Fact Sheet, the TDAPA is paid for a period of two years, but the agency is instituting the add-on payment in order to support the Medicare ESRD beneficiaries’ continued access to the new products. Kidney Care Partners said the one-size-fits-all approach would create a payment cliff for innovation of new products.