The Centers for Medicare and Medicaid Services proposes a 3.1% Medicare pay hike for dialysis providers next year and lays out plans for quality improvement in a draft regulation issued Tuesday.
The proposed rule would hike the base rate for dialysis services by $6.19 to $264.09. The regulation would increase payments to hospital-based end-stage renal disease providers by 3.7% and to freestanding facilities by 3.1%, according to CMS.
CMS also wants to suppress four metrics from its quality-improvement program next year to account for the effects of COVID-19, including a readmission ratio and a measure of prevalent patients waitlisted. CMS will collect and post the data but not factor them into payments.
The agency proposes adding healthcare employees' COVID-19 vaccination status as a factor in its the quality measurements starting in 2025. Facilities would need begin reporting that information in 2023.
CMS also wants to convert the standardized transfusion ratio reporting measure, which tracks how many red blood cell transfusions a facility performs relative to the national average, into a clinical measure starting in 2025.
The regulation would update scoring methodology so dialysis providers that meet prior minimum data and eligibility requirements receive scores based on clinical value. CMS proposes converting the clinical measure for hypercalcemia—when calcium levels in the blood are too high—to a reporting measure and identifying replacement metrics that more accurately reflect quality improvement.
Additionally, the agency requests input about home dialysis quality indicators. Some quality measures apply to home dialysis, but not all. Providers that perform higher rates of home dialysis are subject to fewer quality measures as a result.
CMS also solicits feedback on how to use measurement and stratification to improve health equity at ESRD facilities and on whether to include social determinants of health screening measures in future payment regulations.
The proposed rule includes changes to the scoring methodology and patient education services under the ESRD Treatment Choices Model. The mandatory Center for Medicare and Medicaid Innovation payment initiative began in January 2021 and runs through June 2027. CMS modified the model last year to create incentives for providers to reduce disparities in home dialysis and kidney transplant rates.
The agency also proposes add-on payment adjustments for three new dialysis-related products.