Kidney Disease Education Part of 2010 CMS Proposals

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Kidney Disease Education Part of 2010 CMS Proposals

Copyright 2009 by Virgo Publishing.
http://www.renalbusiness.com/
Posted on: 07/02/2009

WASHINGTON—Stage 4 chronic kidney disease patients will have access to six, one-hour Medicare-reimbursed pre-dialysis education sessions next year, according to the Centers for Medicare & Medicaid Services’ Physician Fee Schedule Changes for 2010.

“Individuals could benefit from education interventions due to the large amount of medical information that could affect patient outcomes including the increasing emphasis on self-care and patients’ desire for informed, autonomous decision-making,” CMS wrote in the proposed rule. “There is evidence that many pre-dialysis patient lack knowledge about their condition and may develop a sense of despair regarding their condition.”

Starting Jan. 1, 2010, the education services would be provided to stage 4 chronic kidney disease patients. In the proposal, CMS defined stage 4 as a GFR between 15-29 mL/min/1.73m2. “Because there are currently no agreed upon accepted clinical guidelines that describe the stage IV patients who would eventually require dialysis or a kidney transplant, we are proposing to cover all stage IV patients,” CMS wrote.

CMS wrote that pre-dialysis education can help patients better understand chronic kidney disease, their treatment options, and may also help delay the need for dialysis. “Education interventions should be patient-centered, encourage collaboration, offer support to the patient, and be delivered consistently,” CMS wrote.

Kidney disease education was mandated by the Medicare Improvements for Patients and Providers Act, which passed last year. In order to develop the proposed rule, CMS held two meetings with the renal community, and also consulted medical evidence, literature and available CKD patient education programs.

Based on feedback from these meetings, CMS proposed that face-to-face meetings should be the way the kidney disease education is delivered to the patient. However, patients can also use group education if it is a better way for them to learn.

CMS listed the following as qualified people to provide the education: a physician, physician assistant, nurse practitioner, or clinical nurse specialist. Payments to a qualified educator will be made by Medicare, which has proposed two G-codes for billing purposes. Six sessions will be covered by Medicare, under the proposal. In addition, CMS proposed that each education session last 60 minutes.

In rural areas, CMS proposed that “provider of services” can be qualified kidney disease educators. These include a hospital, critical access hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, or a hospice program. Dialysis clinics, however, are not part of this qualified list.

CMS did not, however, propose specific education, training, and certification requirements, but did say that it is seeking public comments on these issues.

In addition, CMS said it is important that the education sessions be assessed when they end in order to make them more effective for future kidney disease patients. Therefore, CMS proposed that the patient be assessed during at least one education session. The assessment would measure the patient’s CKD knowledge. CMS said it is seeking public comment on how to develop these assessments.

Comments need to be made to CMS by 5 p.m. on August 31. Electronic comments can be made at http://www.regulations.gov/. (Follow the instructions under the "More Search Options" tab.)

“The intent of the education services is for the beneficiary to take the information he or she has learned during the education sessions in order to facilitate active participation by the beneficiary in the healthcare decision-making process with the physician managing his or her kidney condition,” CMS wrote in the proposal.

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