CMS RAISES DIALYSIS REIMBURSEMENT FOR 2012, REVISES QIP

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CMS RAISES DIALYSIS REIMBURSEMENT FOR 2012, REVISES QIP
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Posted in News, Centers For Medicare & Medicaid Services (CMS), Bundle Payment, Government & Regulation, Practice Management, Business, Anemia, Erythropoietin-Stimulating Agents (ESAs), Reimbursement

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) released a final rule Nov. 1 that increases dialysis reimbursement in 2012 and alters the  quality incentive program (QIP) by removing the lower hemoglobin target for anemia management in 2013 and expands the number of quality measures in 2014.

Click HERE to read the final rule, which will also appear in the  Nov. 10, 2011, Federal Register.

Payment rates for dialysis treatments will increase by 2.1 percent in  2012, reflecting the ESRD market basket increase of 3 percent less a productivity adjustment of 0.9 percent, as required by statute.  CMS estimated that Medicare payments to ESRD facilities in 2012 will total $8.3 billion.

The provisions in the final rule will be effective for payments to dialysis facilities furnished on or after Jan. 1, 2012; and the new requirements for the ESRD QIP described in the  final rule will affect the payment rates in payment years 2013 and 2014.

“This is the second year of a four-year transition to the new fully bundled payment system for certain dialysis facilities, although nearly 90 percent of facilities have chosen to forgo the transition and be paid entirely under the new system,” said Jonathan Blum, deputy administrator and director of the Center for Medicare.  “We believe that the policies and rate changes we are announcing today will ensure that beneficiaries diagnosed with ESRD will continue to have access to the care they need."

Under the QIP, payments to individual facilities are reduced if the facility does not achieve a certain total performance score based on their performance with respect to measures that assess the quality of dialysis care the facility provided.

The initial ESRD QIP, finalized in a rule earlier this year, will affect payments to individual facilities in 2012 based on their performance on performance standards CMS established with respect to two anemia management measures and one measure of dialysis adequacy.

For 2013, CMS will give equal weight to the two finalized measures: (1) an anemia management measure of hemoglobin levels greater than 12 g/dl and (2) a hemodialysis adequacy measure as measured by a Urea Reduction Ratio (URR) of at least 65 percent.

For 2014, CMS is retaining one anemia management measure (hemoglobin level greater than 12 g/dl) and the dialysis adequacy measure (URR of at least 65 percent). CMS is also adopting four new measures that expand the breadth of the program and will give greater insight into the quality of care Medicare patients with ESRD receive in dialysis facilities.  Specifically, CMS is adopting the following six measures for 2014:

Dialysis adequacy, as measured through the URR, which assesses the percentage of patients with a URR of at least 65 percent;
Anemia management, as measured by the rate of patients with a hemoglobin level greater than 12 grams per deciliter;
Percent of patients receiving treatment through an arteriovenous fistula or catheter–  types of vascular access used to connect patients’ bloodstreams to dialysis equipment for cleansing;
Whether the facility reports certain dialysis-related infections to the Centers for Disease Control & Prevention’s National Healthcare Safety Network;
Whether the facility administers a patient experience of care survey; and
Whether the facility monitors phosphorus and calcium levels on a monthly basis.
The final rule also adopts two changes to how CMS will score a facility’s performance under the QIP—one change relates to the two-measure framework for 2013, and the second change outlines how CMS would score facilities on the six measures adopted for 2014.

“CMS believes that new concerns about the safety of ESAs for dialysis patients strongly argue for providers to work more closely with their patients to develop anemia management strategies that respond the patient’s unique medical issues, rather than adopting a one-size fits all approach to care,” said Patrick Conway, MD, CMS chief medical officer and director of the Agency’s Office of Clinical Standards & Quality.  “This patient-centered approach should result in better treatment outcomes. We plan to monitor hemoglobin levels by facility and to transparently share this information with consumers.”

http://www.renalbusiness.com/news/2011/11/cms-raises-dialysis-reimbursement-for-2012-revises-qip.aspx