In a report to Congress, the CMS described ways to implement a fully bundled prospective payment system for dialysis services. Currently, Medicare pays for certain dialysis services through a partially bundled system known as the composite rate, in which about 60% of total Medicare payments for these services goes to end-stage renal-disease facilities, while the remaining 40% is used for separately billed items, including drugs, laboratory services, supplies and blood products, according to the CMS. End-stage renal disease, or ESRD, is the only category for Medicare eligibility that is based on a specific diagnosis without regard to the patients age.
Acting CMS Administrator Kerry Weems said in a news release that the agency is about 60% of the way to a proven prospective payment system for ESRD and that such a system would create incentives to furnish dialysis services efficiently. The 118-page report suggested establishing a base treatment payment rate for the services related to a dialysis session, including the services in the current composite rate and items that are billed separately. The base rate would be adjusted for case mix factors such as the patients age, gender, height and weight, and how long they have been on dialysis, CMS said in a news release.
We are pleased to see the report recognizes the underfunding of the composite payment rate which cites the average cost of a treatment was $162 vs. a reimbursement of $143.20, said Robert Foreman, president of the Kidney Care Council, a Washington-based association of 11 renal-care companies, in a written statement. -- by Jessica Zigmond
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