Health Information Management

Healthcare News: CMS proposes new payment system for dialysis facilities

JustCoding News: Outpatient, September 23, 2009

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On September 14, CMS proposed a new prospective payment system for facilities that provide dialysis services to Medicare beneficiaries who have end-stage renal disease.
The proposed PPS would provide to dialysis facilities a single bundled payment, which would cover items and services, including dialysis treatments, prescription drugs, and laboratory tests.

CMS proposed three quality measures, which are based on Dialysis Facility Compare data, that it would use for its quality incentive program:

  • Anemia: Number of facility patients whose anemia (low red blood cell count) wasn’t controlled (hemoglobin less than 10.0 g/dL or hemoglobin greater than 12.0 g/dL)
  • Hemodialysis adequacy: Number of facility patients who had enough waste removed from their blood during dialysis treatments (Urea Reduction Ratio (URR) of 65 or greater)
  • Patient survival: Whether patients treated at the facility generally live as long as or longer than expected, or whether they don’t live as long as expected

“Combining a fully bundled prospective payment system with required performance standards would encourage facilities to operate more efficiently and ensure that beneficiaries receive high quality care, while saving dollars for both beneficiaries and the Medicare program,” said Jonathan Blum, director of the CMS Center for Medicare Management, in a press release.

Under the proposed rule, CMS would establish a base bundled payment rate of $198.64 for all of the services related to a dialysis session, including the services in the current composite rate as well as items (e.g., oral drugs) that are billed separately.

CMS will accept comments on the proposed rule through November 16 and will respond to such comments in a final rule to be issued in 2010. The new payment system would apply to dialysis services furnished to Medicare beneficiaries on or after January 1, 2011.

Access a related CMS fact sheet.



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