CMS Issues Payment Rule, Quality Incentive for Dialysis Providers

Cheryl Clark, for HealthLeaders Media , July 27, 2010

According to a Medicare statement released yesterday, both the new prospective payment system and the proposed QIP are required by the Medicare Improvements for Patients and Providers Act of 2008. That law requires that dialysis facilities be paid a single bundled rate for renal dialysis services and home dialysis. The proposed QIP creates payment incentives for dialysis facilities to improve patient outcomes.

Currently, Medicare pays for certain dialysis services under a partial bundled rate, referred to as the composite rate, which represents 60% of total Medicare payments to end stage renal disease facilities.  The remainder is billed separately for drugs and non-routine lab testing.

The new bundled case-mix adjusted payment includes dialysis treatments and supplies, end-stage renal disease drugs and clinical lab tests. It sets a base payment rate of $229.63 for each dialysis treatment, which includes payment for services in the current composite rate, as well as most items and services now paid for separately.

The QIP proposal includes several quality measures, including whether patients are receiving appropriate treatment for anemia and whether patients’ urea reduction ratios—indicating whether dialysis treatments are effectively removing waste—are working as well as they should. 

According to CMS, “the law requires CMS to reduce the payment rates to a dialysis facility by up to 2% if that facility fails to meet or exceed the established performance scores with regard to performance standards established for each quality measure,” and would take effect after Jan. 1, 2012.

Facilities that receive Medicare payment are already reporting their performance to CMS according to law. 

Also, the proposed QIP rule includes options for making facility performance scores available to the general public, and to patients.


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