Doctor: Medicare rule may discourage home dialysisBy Rita Rubin, USA TODAY
Medicare's just-released proposed rule for revamping how it pays for treating chronic kidney failure could discourage dialysis centers from training patients to dialyze at home, a University of Washington kidney doctor said Wednesday.
As expected, the rule "bundles" the reimbursement for dialysis into a single payment, with a base rate of $198.64 per treatment. Patient and location factors, such as the local wage index, could raise the payment. Currently, dialysis centers receive a payment per treatment, but they bill Medicare separately for costly injectable drugs and some lab tests. Added together, that averages to about $261 per treatment, Medicare estimates.
DIALYSIS IN USA: High costs, high death rates
Medicare also has been paying an extra $12 or $20 for treatments during which centers train patients to dialyze at home, but the proposed rule, released late Tuesday, eliminates that.
Only 8% of the more than 350,000 U.S. dialysis patients treat themselves at home, where they can dialyze longer or more frequently than in a center — which, research suggests, results in greater survival.
"The thing that disturbs me about what I've seen so far (of the bundling details) is the idea that they're going to put the training costs in the bundle," says Christopher Blagg, professor emeritus of medicine at the University of Washington. Without an extra payment for training, Blagg says, dialysis centers won't make up the cost until a patient has been dialyzing at home — which is less expensive than in-center — for a year or two.
The Centers for Medicare & Medicaid Services will accept comments on the proposed rule through November and issue a final rule in 2010. The new system is to go into effect Jan. 1, 2011.
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