CMS proposes Medicare payment changes to increase the use of dialysis in the home

The Centers for Medicare and Medicaid Services has proposed payment changes to support the use of dialysis in the home.

The proposed rule in the Medicare End-Stage Renal Disease Prospective Payment System would allow for payment for certain new and innovative equipment and supplies used for dialysis treatment of patients at home. 

These proposed changes would encourage the development of certain new and innovative home dialysis machines, CMS said.
 
CMS is proposing to expand the transitional add-on payment adjustment for new and innovative equipment and supplies that was introduced last year to now cover qualifying new dialysis machines when used in the home. 

This would provide a new payment mechanism to expand access and faster availability to Medicare beneficiaries.

Refinements to eligibility for the transitional drug add-on payment adjustment to better target the additional payment to innovative renal dialysis drugs and biological products is based on the Food and Drug Administration's New Drug Application Classifications.

WHY THIS MATTERS 

Currently, more than 85% of Medicare fee-for-service beneficiaries with ESRD travel to a facility to receive their dialysis at least three times per week. 

They spend, on average, 12 hours each week attached to a dialysis machine away from home. 

Dialysis patients are among the most vulnerable population covered by Medicare and many have multiple chronic conditions and comorbidities. 

The ESRD population also has the highest hospitalization rates due to COVID-19 among Medicare beneficiaries, highlighting the importance that this population stay at home during the public health emergency to reduce risk of exposure to the virus.  

The coalition Kidney Care Partners said it is supportive of CMS's changes but is disappointed the agency did not address a long-standing issue having to do with the adjusters and the underlying methodology used in the ESRD PPS bundle that leads to money being taken away from patient care. 

The original methodology in the budget neutral system misdirects money in that some facilities that don't need it, get it, while others are getting less than they need, according to Kathy Lester, counsel to Kidney Care Partners. 

"The math is wrong," Lester said. "What's happened is the adjusters take money out of the system and hold it and distribute it to patients who are more expensive."

KCP wanted CMS to propose changes that were also recommended by the Medicare Payment Advisory Commission and said she believes the agency is still looking at that.  

THE LARGER TREND

The announcement builds on previous actions taken by CMS to improve care for beneficiaries with kidney disease including: the proposed ESRD Treatment Choices Model that would encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries; and the Kidney Care First and Comprehensive Kidney Care Contracting Options of the Kidney Care Choices  Model that will test whether new care delivery and Medicare payment options can improve the quality of care and reduce the total cost of care for patients with kidney disease.

The proposed rule builds on the Trump Administration's executive order on Advancing American Kidney Health.

ON THE RECORD

"CMS data shows that those with ESRD have the highest rate of hospitalization of any single group, a trend consistent with having to frequently leave home to receive dialysis," said CMS Administrator Seema Verma. "In the midst of a deadly pandemic that poses a particular threat to those with serious underlying conditions, President Trump's call for increased access to home dialysis has never been more urgent. Unfortunately, government rules too often stand in the way. Today's action represents a sorely needed course direction, making it easier for ESRD facilities to make new and innovative home dialysis machines available to patients who need them."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com