CMS proposes an enlarged bundle for routine dialyis care

[Bill Peckham]

On Wednesday CMS released a long anticipated report to Congress on expanding the current dialysis bundle. It's 114 pages - I'm working my way through it but since CMS's proposed bundle would remove resources from the dialysis program I am against it for that reason alone. I am looking at it in more detail to try and figure out all the implications. I have five posts and counting on my blog about bundling http://www.billpeckham.com/from_the_sharp_end_of_the/dialysis_esrd_payment_bundle/index.html and I will be going to DC the first week of March for meetings including a day and a half meeting just on bundling.

Is anyone else following this issue?

link: CMS's Report to Congress "A Design for a Bundled End Stage Renal Disease Prospective Payment System" PDF link
http://www.cms.hhs.gov/ESRDGeneralInformation/downloads/ESRDReportToCongress.pdf

[BigSteve]

Bill, I haven't printed out the paper so I can't comment on it, but have the national organizations
like AAKP and others taken a postion yet?

[Bill Peckham]

Bill, I haven't printed out the paper so I can't comment on it, but have the national organizations
like AAKP and others taken a position yet?

In June of last year AAKP testified before Congress in favor of bundling http://waysandmeans.house.gov/hearings.asp?formmode=view&id=6176
as I posted I can't make sense of this position http://www.mydd.com/story/2007/6/28/16124/0529

The RSN is going to have a meeting about bundling in DC on 3/7-8/08 - they haven't taken an overt position. I'll be at the meeting http://www.billpeckham.com/from_the_sharp_end_of_the/2008/02/lets-talk-about.html

DPC is in favor of bundling - no surprise there - but their written position (PDF LINK) http://www.dialysispatients.org/site/DocServer/070620_Revised_Bundling_policy.pdf?docID=981 is not as overt in support as aakp's testimony.

Other groups in favor of bundling - sight unseen - include NKF and AKF. Other than myself I do not know anyone who has come out against bundling.

I just have a hard time believing that people who rely on dialysis to keep them alive are in favor of cutting funds from the dialysis program. Somehow there is a meme that bundling is good in and of itself regardless of the details of the new reimbursement scheme.

I say let's talk about the goals first. Then evaluate options to reach those goals. If the goal is to pay less money for medications then Medicare should negotiate the price directly and pay providers a nominal fee to distribute the medications. If the goal is to remove the profit from the administration of medications then Medicare should negotiate the price directly and pay providers a nominal fee to distribute the medications. If the goal is to remove the incentive to over dose patients then Medicare should negotiate the price directly and pay providers a nominal fee to distribute the medications.

The appeal of bundling is that it allows CMS to leave the decisions to providers on how to spend less on dialysis. Just pay them less and let them figure it out. Is that really the best we can do? How about changing the current bundle to a monthly bundle that is enhanced retrospectively if the dialyzor stays out of the hospital? Allow Medicare to negotiate Part B medication prices directly taking dialysis providers out of the drug business, allowing them to concentrate on dialysis and keeping their patients healthy.