CMS boosts spending estimate for kidney failure patients
The CMS will be paying dialysis centers 10 times more than previously stated after the agency found it underestimated the number of acute kidney injury patients that will now be getting care at dialysis centers instead of hospitals.
Dialysis centers only started receiving Medicare reimbursement for kidney injury patients in January. Previously, the patients were usually treated in acute-care settings. The CMS said at the time it wanted to give patients the option to be treated in their communities as well.
The agency initially estimated that few of these patients would go to dialysis centers in 2018, and it would only spend $2 million on acute kidney injury patients receiving care at the facilities.
But providers told the agency that estimate was dramatically low. The CMS revised its estimated budget to $20 million after industry pointed out that outpatient data used to estimate the shift in services from the outpatient hospital setting to the end-stage renal disease facility may lowball the number of beneficiaries that received treatment for acute kidney injury due to inconsistencies in how hospitals bill for treatments of these patients.
"We used the best available information, which was information regarding treatments provided in a hospital outpatient setting," the CMS said in the rule. "In the time between the publication of the proposed rule and the final rule, data regarding actual ESRD (end-stage renal disease) facility utilization of treatments provided to beneficiaries with AKI (acute kidney injury) has become available."
The CMS now projects that it will spend $20 million next calendar year on such patients it announced in the final CY 2018 pay rule for dialysis centers.
Even that estimate could be wrong, according to the Kidney Care Council, an association of dialysis providers. It projects the CMS could end up spending $50 million next year, according to a survey of its members.
Overall, the CMS expects dialysis centers to get $80 million in additional funds next year which is the same raise they received between 2016 and 2017.
With that raise, Medicare expects to pay approximately $9.8 billion to approximately 6,750 end-stage renal disease facilities in 2018.
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