Medicare payments for end-stage renal disease will increase by 0.3% in 2015 under a final rule (PDF) issued by the CMS Friday. The agency expects to pay $9 billion next year to more than 6,000 facilities for coverage of dialysis services to individuals with ESRD.
Providers warned that the payments levels proposed by the CMS for future years won't allow facilities to remain financially viable. More than 80% of dialysis patients rely on Medicare for coverage.
“The result of CMS' (prospective payment system) rule for 2015, without further intervention and course correction in future years, will in 2018 result in 77% of facilities operating with a zero or negative Medicare margin and the mean gross Medicare margin for facilities being negative 7.4%,” wrote Cherilyn Cepriano, executive director of the Kidney Care Council, in comments to the CMS. “This is clearly unsustainable.”
But the CMS stuck to the payments outlined in its proposed rule in July. The 2015 payment adjustment will vary slightly depending on the type of facility. Hospital-based treatment facilities can expect a boost of 0.5%, while stand-alone facilities would see an increase of 0.3%. In addition, urban facilities that treat ESRD patients will see a 0.4% bump, while rural treatment centers can expect payments to decrease by 0.5%.
The rule also finalizes changes to a quality incentive program for dialysis providers that will take effect for 2017 and 2018 payments. Dialysis facilities that don't meet a certain quality threshold will see their Medicare payments reduced. That's expected to result in reduced payments of $11.9 million in 2017 and $7 million in 2018.
Many commenters had complained that the number of measurements proposed for the system is onerous and will drive up costs for facilities. But the CMS decided that the additional metrics are needed. “Although we recognize that adopting more measures in the (End Stage Renal Disease Quality Improvement Program) increases costs to facilities as well as CMS, we believe these increased costs are outweighed by the benefits to patients of incentivizing quality care in the domains that the measures cover,” the final rule states.
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