At the end of June, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) that includes updates for renal dialysis payments and requirements for the ESRD Quality Incentive Program.
Renal dialysis services will get a 2.2% raise in both freestanding clinics and hospital-based dialysis centers, amounting to $273.20. Healthcare Finance News reports that Medicare expects to pay $7.2 billion to 7,700 ESRD facilities for renal dialysis services. The ESRD PPS bundles payments per treatment to ESRD facilities for all services provided for outpatient dialysis and is adjusted on a per-patient basis, which can also include a training payment for home and self-dialysis modalities, outliers for higher-cost patients and add-ons for certain drugs and supplies.
The response from the dialysis industry was frustrated and accusatory that CMS is unable to grasp the severity of the financial issues facing the kidney care community. According to Modern Healthcare, the rule includes a proposal that would bundle oral-only drugs for kidney patients, making dialysis providers responsible for supplying these medicines instead of retail pharmacies. In a statement, Kidney Care Partners, the dialysis lobby, stressed that this could harm not only companies’ bottom lines but also the dialysis care workforce:
KCP is deeply concerned about the sustainability of the program given that the market basket fails to reflect the actual increase in costs incurred by facilities. Moreover, we are disappointed that CMS did not heed the kidney care community’s call for reforms to address the barriers the current payment policies have created in terms of patients being able to access innovative treatment options
The fact sheet for the proposed rule can be reviewed at the Centers for Medicare and Medicaid Services. The rule would go into effect on January 1, 2025.
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