VA proposing to use Medicare rates to cover outpatient dialysis services

[okarol]

VA proposing to use Medicare rates to cover outpatient dialysis
 services




4/9/2010

The Department of Veterans Affairs says it can save 39% in payments to 
non-VA managed dialysis clinics for patient services, and 75% in lab test
payments by switching to Medicare pricing.



A proposed rule to change the payment rates for both inpatient and
outpatient non-VA services appeared in the Federal Register on Feb. 19;
responses to the proposal are due April 19.



The proposed rule would set a national payment methodology based on Medicare
rates; if approved, the VA estimates it could save $251 million in 2011 for
all non-VA services.



In addition to payment changes for dialysis and laboratory services, the
rule covers ambulatory surgical centers, home health care, and hospice.
As part of its payment review, the Department looked at dialysis services
and laboratory tests provided to veterans in the first six months of 2008.
The VA calculated the impact of paying current non-VA provided dialysis
claims for dialysis treatments and for separately payable injectable drugs
with current Medicare pricing. An average Medicare composite rate of $157
per dialysis session was used in the analysis, adjusted using Medicare's
geographic wage index.

"By utilizing Medicare pricing we estimate that VA's outpatient dialysis facility expenditures will decrease by 39%," the VA said.



To estimate the impact of using Medicare's clinical lab fee schedule, the VA
focused on the 100 clinical lab services (by CPT code) with the highest
aggregate non-VA (purchased care) allowed amounts. These 100 codes accounted
for about 86.5% of all non-VA clinical lab service costs. The Department
then calculated the impact of paying these non-VA clinical lab claims using
Medicare's fee schedule as the maximum allowable charge.



"We found that VA paid an average of almost $49 per line item for clinical
lab services for the top 100 VA purchased care clinical lab services. Under
Medicare pricing, the VA would pay an average of $11.47 for these claims.
This represents a cost reduction of approximately 75%," the Department wrote
in the proposed rule.



The proposed rule is available at
 www.thefederalregister.com/d.p/2010-02-18-2010-3042.

http://www.nephronline.com/news.asp?N_ID=3729