CMS gives renal dialysis facilities a 2.7% increase

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Among a spate of final rules issued by the Centers for Medicare and Medicaid Services is one updating payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries in 2025. 

For 2025, CMS is increasing the ESRD PPS base rate to $273.82, with the expectation that this will increase total payments to all ESRD facilities, both freestanding and hospital-based, by about 2.7%.

Under the ESRD PPS, Medicare expects to pay $6.6 billion to about 7,700 ESRD facilities. The base rate of $273.82 is an increase of $2.80 from the current CY 2024 base rate of $271.02.

WHAT'S THE IMPACT?

CMS said it's finalizing a new ESRD PPS-specific wage index that will be used to adjust ESRD PPS payments for geographic differences in area wages. This method combines data from the Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) program and freestanding ESRD facility cost reports to produce the index. 

The index, CMS said, will be used to determine geographic payment adjustments in lieu of the hospital wage-index values for each geographic area used in past years, which are derived from hospital cost-report data. 

The agency is also expanding the list of ESRD outlier services to include drugs and biological products that were or would have been included in the composite rate prior to establishment of the ESRD PPS. This, CMS said, is to better recognize cost drivers for providing renal dialysis services under the PPS.

Also finalized was the proposal to modify the Low-Volume Payment Adjustment (LVPA) policy to create a two-tiered LVPA, whereby ESRD facilities that furnish fewer than 3,000 treatments per cost-reporting year will receive a 28.9% upward adjustment to the ESRD PPS base rate. ESRD facilities that furnished 3,000 to 3,999 treatments will receive an 18.3% adjustment.

THE LARGER TREND

In addition, CMS is finalizing its proposal to allow payment for acute kidney injury (AKI) renal dialysis services furnished to beneficiaries in their homes. CMS will permit ESRD facilities to bill Medicare for the home and self-dialysis training add-on payment adjustment for beneficiaries with AKI.

CMS said this delivers more flexibility to beneficiaries with AKI in making decisions about their care.

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.