Medicare rates for 2014 Dialysis

[obsidianom]

Reuters Health Information

U.S. Medicare Program Leaves Dialysis Payments Unchanged
November 25, 2013


(Reuters) - Medicare, the U.S. government healthcare program for elderly and disabled people, will leave its overall reimbursement rates for kidney dialysis treatment unchanged for next year, and said it will take three to four years to implement a mandated adjustment to its base rates.

The 2014 payment rates are much less onerous than the 9.4% cut proposed by the agency in July.

The rates, announced on Friday by the Centers for Medicare and Medicaid Services (CMS), the federal agency that sets reimbursement rates for Medicare, come on top of a 2% reduction that kicked in earlier this year under automatic cuts to federal spending.

CMS said the final rule also finalized a 50% increase to home dialysis training payment adjustments. The agency said the rates reduce Medicare payments by 1.05%, the combined effects of an increase in the home health payment update percentage of 2.3%, offset by a decrease of 2.7% - the result of adjustments required by the Affordable Care Act - and a 0.6% decrease due to a refinement of the payment system.

Fresenius Medical Care AG, or FMC, and DaVita Healthcare Partners Inc are the largest dialysis providers in the United States.

FMC operates more than a third of the dialysis treatment centers in the United States and Medicare contracts account for about 30% of its revenues.

The industry had lobbied for more moderate cuts, arguing that lowering payments by 9.4% would force smaller operators out of business, hitting patient care mainly in rural areas.

The proposed reimbursement cuts for dialysis providers mainly reflect a drop in the use of the expensive hormone erythropoietin, or EPO, to treat anemia, a common side effect of dialysis.

Lower use of EPO came as a result of medical studies showing the dangers of overuse and after a new reimbursement regime was introduced in the U.S. that encouraged prudent use of EPO and more use of cheaper drugs that can partially substitute for EPO.

FMC, indirectly controlled by a German charitable trust, derives about two-thirds of its total revenues from North America.

FMC launched a cost-cutting program at the beginning of the year in response to U.S. austerity measures, but it has not provided details.

[Zach]

Less reported was the fact that CMS raised the payment for a single home hemodialysis training session from $33.44 to $50.00 for a total of 25 sessions.

[Bill Peckham]

Less reported was the fact that CMS raised the payment for a single home hemodialysis training session from $33.44 to $50.00 for a total of 25 sessions.

 

Raised the home dialysis training add on - you get the normal ~$250 allowed plus the add on

[kporter85db]

Does Medicare pay for ALL home dialysis sessions or only three?

[Bill Peckham]

Does Medicare pay for ALL home dialysis sessions or only three?

There is not a published policy, it is very much a grey area and no one wants to talk about it for fear of rocking the boat.

The short answer is mostly yes but actual payment decisions are determined by (the check is written by) fiscal intermediaries of which there are many. The country is divided up into IIRC 18 zones but some FIs cover more than one zone, so I think there are in fact 10 different FIs. It is up to the provider to bill for every treatment and for the FI to pay so no one can make a blanket statement, it depends on if the provider bills and then if they do if the FI pays. Mostly the answer to those questions is Yes but no one knows for sure to what extent.

I was thinking of starting a project of collecting Explanation of Benefits from dialyzors - Just black out any personal info an send me your EB. I wouldn't need too many to create a very interesting picture. Would you be willing to share your EB?

[kporter85db]

I was thinking of starting a project of collecting Explanation of Benefits from dialyzors - Just black out any personal info an send me your EB. I wouldn't need too many to create a very interesting picture. Would you be willing to share your EB?

Absolutely Bill. It may take me a week or so to get it done. I'm having my PD catheter removal surgery tomorrow morning. I going out of town this weekend. And I'm having my second fistula surgery next week. But I will get them scanned in and can email or fax them to you.

I've only been doing Nxstage for about a month so mine would reflect my time on PD.

[Bill Peckham]

I've only been doing Nxstage for about a month so mine would reflect my time on PD.

Great opportunity to see before and after, with some incenter thrown in. Actually the whole transition seen through the billing lens could be very interesting. Are you Medicare Primary?