Healthcare Business News

Final rule lowers renal-facilities pay bump

By Rich Daly
Posted: November 2, 2012 - 6:45 pm ET

End-stage renal disease facilities will receive a smaller-than-anticipated 2.3% CMS rate boost next year, according to a final rule issued Friday (PDF).

The final rule's increase reflects a 2.9% bundled market basket increase reduced 0.6% by a statutorily required productivity adjustment.

A proposed rule issued in July had called for a 3.2% increase in the base payment rate reduced by a productivity adjustment of 0.7% and resulting in an increase of 2.5%.

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The reduced update stems from the third-quarter 2012 market basket forecast by IHS Global Insight, a financial forecasting firm that the CMS uses to identify market costs.

The rate boost still will increase payments next year at the 5,726 kidney disease treatment facilities to $8.4 billion, the CMS estimated.

The 301-page final rule also laid out specifics of a quality incentive program, which aims to improve care quality and patient outcomes. The rule specified that the CMS will use 2013 performance scores on the QIP measures for a broader range of patients to calculate dialysis facilities' payments in 2015.

Next year marks the third year of the four-year transition to a new ESRD payment system, although 90% of such facilities previously opted to receive payment entirely under the new system, according to the CMS.

About 20%, or 1,093, of ESRD facilities will likely face payment reductions of up to 2% in 2015 under the rule's final QIP measures, the CMS estimated.

The final rule also implemented a provision in the Middle Class Tax Relief and Job Creation Act of 2012 that reduces bad debt payments for certain Medicare providers while removing a cap on bad debt reimbursement to ESRD facilities.

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