In just a few weeks, dialysis providers will learn whether CMS will reduce Medicare dialysis reimbursement by 9.4 percent beginning in 2014. Next month CMS is expected to publish a final rule to its July proposal that would update the End-Stage Renal Disease Prospective Payment System for renal dialysis services in the form of cuts to dialysis funding that are expected to save Medicare $4.9 billion over 10 years, according to a Renal Business Today report.
The proposed new rate is based upon re-pricing (rebasing) the bundled payment to dialysis providers to take into account changes in behavior and use of dialysis drugs, according to a Modern Healthcare report. The current bundled payment rate is based on 2007 treatment protocols, which includes the use of anti-anemia drugs. These medications represent Medicare’s largest drug expenditure, and their use has dropped in the past few years due to a variety of reasons.
Since the proposed cut was announced, dialysis providers and organizations such as the National Kidney Foundation and Kidney Care Partners have urged Congress to vote against the rule, arguing that the reduction in payment could jeopardize care as Medicare reimbursement for dialysis services would "now fall well short of covering the cost of care," according to a kidney specialist quoted in an Idaho State Journal report. Of the 415,000 Americans who depend on dialysis, 85 percent rely on Medicare to pay for their treatments, according to a The Hill blog post. The proposed cuts would reduce reimbursement per dialysis treatment from $240 to $216.
It has been argued that dialysis providers could make up a large portion of this loss in reimbursement by stopping bundle "leakage" — money that facilities fail to capture that is included in the bundled payment, such as additional amounts for care of patients with more complex, and therefore higher reimbursing, conditions. As a Nephrology News & Issues report discusses, stopping the leakage is not as easy as it sounds for the industry, but in addition to the proposed Medicare reimbursement cuts, tackling this leakage/efficiency issue will continue to be one focal point for an industry constantly striving to provide high quality service in a economically viable manner.