The Centers for Medicare and Medicaid services unveiled a final rule for next year's end-stage renal disease payments on Friday that includes a small increase for freestanding and hospital-based dialysis.
The rule also aims to promote at-home dialysis services and transplant care for people from underserved communities, which marks the agency's first effort to tackle health disparities for Medicare enrollees with kidney failure in the decade since Congress established the prospective payment system for ESRD providers. CMS published the proposed rule for ESRD payments in July.
"Today's final rule is a decisive step to ensure people with Medicare with chronic kidney disease have easy access to quality care and convenient treatment options," said CMS Administrator Chiquita Brooks-LaSure. "Enabling dialysis providers to offer more dialysis treatment options for Medicare patients will catalyze better health outcomes, greater autonomy and better quality of life for all patients with kidney disease."
Disparities among end-stage renal disease patients are well-documented. Hospital readmission rates are 19% higher for Black ESRD patients than for white ones, according to CMS. People of color also face higher costs for kidney care. Outpatient bills for American Indian, Asian, Black and Hispanic ESRD patients are 5% to 12% higher than those for white patients. People from these populations also are less likely to get in-home dialysis and to be placed on kidney transplant waiting lists.
Under the final rule, CMS will award providers with higher scores if they increase home-based dialysis and transplant rates for Medicare-Medicaid dual eligible enrollees and for low-income beneficiaries. These statuses often are used as a proxies for socioeconomic status and race.
Also under the ESRD Treatment Choices model, which is part of what was finalized Friday, the agency will stratify providers who serve a higher proportion of patients who are dual-eligible or are low-income subsidy recipients in an attempt to not penalize those providers disproportionately.
Also included in the final rule are pay bumps to hospital-based providers of 3.3%, and for free-standing facilities, a bump of 2.5%. All said, the increases represent an estimated 2.5% increase overall from 2021, the agency said. The agency said it is working to address technical issues created by the pandemic and in the quality reporting system overall. As a result, no facility will receive a payment reduction for 2022.
In addition, the regulation will allow providers to offer no-cost kidney disease education services via telehealth after the pandemic public health emergency is over. The agency cited transportation access as a big barrier to these services that were alleviated as a result of the temporary COVID-19 waiver that allowed telehealth delivery.
"Moreover, some beneficiaries, even those with reliable transportation, may be more comfortable receiving kidney disease patient education services via telehealth rather than appearing in person after over a year of social distancing, even when it becomes safe according to federal guidance for such beneficiaries to enter physical spaces with other individuals," the agency stated in the final rule.
Under the 2022 prospective payment system for ESRD, Medicare estimated it will pay $8.8 billion to about 7,700 facilities for dialysis services, and comes with a $4.77 increase to the current base rate of $253.13.
The agency also will postpone reporting on several quality measures that it says would adversely impact providers because of the pandemic, including the standardized hospitalization ratio clinical measure and long-term catheter rate clinical measure.
Moving forward, CMS has asked for feedback on stratification of quality measures by race, disability status, LGBTQ+ status and other factors. It also is asking for feedback on how to move ESRD quality measurement into the digital space.
