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ESRD Proposed Rule Updates Payment Rates, Tweaks Quality Program

July 27, 2017:

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule on June 29 that would affect payment for renal dialysis services for Medicare beneficiaries on or after January 1, 2018. The rule updates payment policies and rates for all services provided under the end-stage renal disease (ESRD) prospective payment system.

Of the more than 661,000 Americans with ESRD, or kidney failure, approximately 468,000 are on dialysis, and about 193,000 have a functioning kidney transplant. Kidney disease kills more people per year than breast or prostate cancer, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

CMS’s rule proposes increasing the ESRD PPS base rate for calendar year 2018 to $233.31, up from $231.55 in 2017. This base rate would also apply to the acute kidney injury (AKI) dialysis rate. The agency is not proposing any change to the wage index and wage index floor for ESRD services, but it is putting forth a decrease in the outlier services fixed-dollar loss (FDL) for pediatric patients to $49.55 from $68.49, and a drop in the Medicare allowable payment (MAP) to $38.25 from $38.29. The outlier FDL for adult patients would increase to $83.12 from $82.92, and the MAP would decrease to $42.70 from $45.00. Outlier payments made up less than 1 percent of total ESRD PPS payments in calendar year 2016.

The rule also proposes some changes to the ESRD Quality Incentive Program (QIP), beginning in payment year 2019. The agency wants to simplify the Performance Score Certificates (PSCs) for the ESRD QIP by shortening them so that they indicate just the facility’s total performance score (TPS), identification, and how the facility compares to the national average. Starting in payment year 2020, the agency would change the ESRD QIP extraordinary circumstances exception (ECE) policy to more closely match that of other Medicare quality programs. Also for 2020, CMS is proposing adjusting the facility sampling method for the National Healthcare Safety Network validation study of dialysis events to make the data better reflect both high- and low-performing facilities.

In an effort to monitor and measure the quality of care AKI patients receive, CMS is asking for feedback on whether and how to adapt current measures to these patients’ needs. The agency also is seeking ideas for new measures that might be needed for this population.

The rule can be accessed online at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-06-29.html.


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