I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Medicare/Insurance => Topic started by: Meinuk on April 05, 2011, 08:30:56 AM
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I've added some basic resources, and as I learn of presentations/powerpoints etc, I'll update here as I can.
AAKP: Understanding the New ESRD Bundle Payment System: How will this change affect me and my dialysis treatments?
Changes in ESRD Medicare Reimbursement: What The Patient Needs to Know - Power Point Slides
http://www.aakp.org/userfiles/File/Bundling-Dr.%20Wish%20Presentation.ppt (http://www.aakp.org/userfiles/File/Bundling-Dr.%20Wish%20Presentation.ppt)
Financing Dialysis & Effects of Bundle on Patients - PowerPoint Slides
http://www.aakp.org/userfiles/File/Financing%20Dialysis%20&%20Effects%20of%20Bundle%20on%20Patients%20-%20Beth%20Witten.ppt (http://www.aakp.org/userfiles/File/Financing%20Dialysis%20&%20Effects%20of%20Bundle%20on%20Patients%20-%20Beth%20Witten.ppt)
RSN [Renal Support Network]
Oldie But Goodie on KidneyTalk! to Listen: http://www.rsnhope.info/programs/kidneytalkshows/Wish_Diane/Wish_Diane_111010.php (http://www.rsnhope.info/programs/kidneytalkshows/Wish_Diane/Wish_Diane_111010.php)
Is It A "Bundle" of Joy? - An Interview with Diane Wish [Dialysis Facility Administrator and wife of Jay Wish MD, presenter of the AAKP Slides above] The "bundling of care" for dialysis services is now in effect. Have you experienced changes in your care? Listen to this interview for an explanation of what the bundle is and the potential impact on patient care and outcomes. So far, has this new payment system delivered?
Renal Economic Symposium of 2010
RENAL ECONOMICS: “THE BUNDLE” EXPLAINED
http://www.atlanticdialysis.com/Downloads/1%20-%20Dr.%20J.G.%20Bhat.pdf (http://www.atlanticdialysis.com/Downloads/1%20-%20Dr.%20J.G.%20Bhat.pdf)
Pharmaceuticals Under the Medicare Prospective Payment System
http://www.atlanticdialysis.com/Downloads/3%20-%20Tracy%20J.%20Mayne.pdf (http://www.atlanticdialysis.com/Downloads/3%20-%20Tracy%20J.%20Mayne.pdf)
The Patient Centered Medical Home
http://www.atlanticdialysis.com/Downloads/5-%20Dr.%20Jai%20Radhakrishnan.pdf (http://www.atlanticdialysis.com/Downloads/5-%20Dr.%20Jai%20Radhakrishnan.pdf)
THE MEDICARE ESRD PROSPECTIVE PAYMENT SYSTEM: CLINICIAN’S PERSPECTIVE
http://www.atlanticdialysis.com/Downloads/2%20-%20Dr.%20Premila%20Bhat.pdf (http://www.atlanticdialysis.com/Downloads/2%20-%20Dr.%20Premila%20Bhat.pdf)
A National Snapshot: Kidney Care Issues and Election Outlook
http://www.atlanticdialysis.com/Downloads/4%20-%20John%20Jonas.pdf (http://www.atlanticdialysis.com/Downloads/4%20-%20John%20Jonas.pdf)
EMR and the Bundle [EMR = Electronic Medical Records]
http://www.atlanticdialysis.com/Downloads/6%20-%20John%20A.%20Sargent,%20Ph.D.pdf (http://www.atlanticdialysis.com/Downloads/6%20-%20John%20A.%20Sargent,%20Ph.D.pdf)
This isn't actually part of the bundle, but it was part of the Renal Economic Conference:
Vascular Acccess Center: Nephrologist as the driver
http://www.atlanticdialysis.com/Downloads/8-%20Dr.%20Arif%20Asif.pdf (http://www.atlanticdialysis.com/Downloads/8-%20Dr.%20Arif%20Asif.pdf)
CMS (Medicare)
CMS ESRD Center: http://www.cms.gov/center/esrd.asp (http://www.cms.gov/center/esrd.asp)
Medicare Program; End-Stage Renal Disease Prospective Payment System [the Bundle]
http://www.federalregister.gov/articles/2010/08/12/2010-18466/medicare-program-end-stage-renal-disease-prospective-payment-system (http://www.federalregister.gov/articles/2010/08/12/2010-18466/medicare-program-end-stage-renal-disease-prospective-payment-system)
Medicare Program; End-Stage Renal Disease Quality Incentive Program [QIP which is Pay for Performance]
http://www.federalregister.gov/articles/2011/01/05/2010-33143/medicare-program-end-stage-renal-disease-quality-incentive-program
CMS Memo 2/17/2011: Clarification of Exclusion of Part D Payment for Drugs Included in the End-Stage Renal Disease Prospective Payment
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/MemoClarifiedESRDGuidance_02.17.11.pdf (http://www.cms.gov/PrescriptionDrugCovContra/Downloads/MemoClarifiedESRDGuidance_02.17.11.pdf)
I posted the CMS PPS Factsheet here on IHD:
CMS implements value-based purchasing for dialysis facilities
http://ihatedialysis.com/forum/index.php?topic=21409.0
Other Resources
Medicare Program; End-Stage Renal Disease Quality Incentive Program
http://govpulse.us/entries/2010/08/12/2010-18465/medicare-program-end-stage-renal-disease-quality-incentive-program (http://govpulse.us/entries/2010/08/12/2010-18465/medicare-program-end-stage-renal-disease-quality-incentive-program)
www.dialysispatients.org. Dialysis Patients’ Guide to the Medicare End Stage Renal Disease (ESRD) Bundle
http://www.dialysispatients.org/patient-guide-the-bundle (http://www.dialysispatients.org/patient-guide-the-bundle)
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Thank you for posting this. Regarding the performance standard, how is it calculated? How many testing samples are taken per month? Is it taken as an average for each patient and that 98% of the patients in each facility has to have an average hemoglobin over 10g/dL each month?
It is also interesting that hemodialysis adequacy for homedialysis patients are not included in the calculation of ESRD QIP (End-Stage Renal Disease Quality Incentive Program).
http://www.federalregister.gov/articles/2011/01/05/2010-33143/medicare-program-end-stage-renal-disease-quality-incentive-program#p-84
Comment: One commenter noted that the proposed initial performance standard based on the 2008 national performance rate of two percent for the Hemoglobin Less Than 10g/dL measure would be extremely difficult for providers/facilities to meet and would likely lead to overuse of ESAs. The commenter noted that the 2008 data reflects practices that were furnished prior to recent studies and FDA warnings regarding the danger of high hemoglobin levels, and that at the time, providers/facilities were unaware of the danger of high hemoglobin levels. Additionally, the commenter suggested setting the initial performance standards for the anemia management measures at 10 percent for Hemoglobin Less than 10g/dL and Hemoglobin Greater than 12g/dL.Show citation box
Response: We disagree with the commenter's suggestion that the anemia management measures performance standards should be set at 10 percent. We have made providers/facilities aware of the dangers of high hemoglobin levels related to use of ESAs since as early as 2005, when we changed our policy regarding ESAs and the monitoring of high hemoglobin levels (see CMS Manual System, Pub 100-04 Medicare Claims Processing, Transmittal 751 (November 10, 2005)). Since that time and with the release of the FDA guidelines in 2008, the historical data demonstrate that the number of patients with high hemoglobin levels has decreased and the number of patients with Hemoglobin Less than 10 g/dL has not increased. We believe that lowering the standard to 10 percent does not move quality forward.
Comment: One commenter requested that the initial performance standard for the hemodialysis adequacy measure be recalculated to reflect that home hemodialysis patients are excluded from the measure.Show citation box
Response: As stated in the ESRD PPS final rule (75 FR 49186), home hemodialysis patients are not part of the measure population for the hemodialysis adequacy measure for purposes of the ESRD QIP. Therefore, home hemodialysis patients will not be included in the measure calculation.Show citation box
After consideration of the public comments, we are finalizing the performance standards as proposed.
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great information ....thx
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Thank you for posting this. Regarding the performance standard, how is it calculated? How many testing samples are taken per month? Is it taken as an average for each patient and that 98% of the patients in each facility has to have an average hemoglobin over 10g/dL each month?
It is also interesting that hemodialysis adequacy for homedialysis patients are not included in the calculation of ESRD QIP (End-Stage Renal Disease Quality Incentive Program).
The Quality Incentive Program has a multipart (complicated) process to come up with a Total Performance Score; a perfect TPS = 30.
Based on last year's performance (2010 outcomes) units have up to 2% of their 2012 reimbursement at risk. The TPS is weighted to penalize Hgb < 10 the most, Hgb < 10 is 50% of the TPS i.e. 1% of reimbursement is at risk, with the other two measures each putting .5% of reimbursement at risk. As far as the when how of blood draws that is a good question - the units are already reporting a Hgb monthly that's what's used on the Dialysis Facility Compare website - I think each monthly Hgb per patient would be the datum that comprise what you're taking 2% from so really it is 2% of the readings being less than 10.
The reason home hemo is excluded is because with increased frequency it can be difficult to achieve a % reduction. Example:
Conventional Dialyzor comes in on Wednesday (lab day should be middle run of week) with a pre urea measure of 100 and post measure 30, for a URR = 70% PASS
Someone on HHD does a blood draw the my second treatment in a row, out of five during the week and has a pre urea measure of 50 and post measure 20, for a URR = 60% FAIL
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The reason home hemo is excluded is because with increased frequency it can be difficult to achieve a % reduction. Example:
Conventional Dialyzor comes in on Wednesday (lab day should be middle run of week) with a pre urea measure of 100 and post measure 30, for a URR = 70% PASS
Someone on HHD does a blood draw the my second treatment in a row, out of five during the week and has a pre urea measure of 50 and post measure 20, for a URR = 60% FAIL
Thanks you Bill.
Our URR is 49% so we failed by that measurement; NxStage 5 days/wk, 4 hour sessions.