Dialysis providers get a 2.2% payment boost
The rule also proposes to extend Medicare payment to dialysis in the home setting for beneficiaries with acute kidney injury.
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The Centers for Medicare and Medicaid Services is giving renal dialysis services a 2.2% pay increase for 2025 in a proposed rule under the End-Stage Renal Disease Prospective Payment System.
The rule also proposes an update to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for 2025 and proposes to extend Medicare payment to dialysis in the home setting for beneficiaries with acute kidney injury.
In addition, the rule provides information on how CMS will operationalize the inclusion of oral-only drugs and proposes to update requirements for the ESRD Quality Incentive Program.
WHY THIS MATTERS
For 2025, CMS is proposing to increase the end stage renal disease prospective payment system base rate to $273.20, which would increase total payments to all ESRD facilities, both freestanding and hospital-based, by approximately 2.2%.
Medicare expects to pay $7.2 billion to approximately 7,700 ESRD facilities for furnishing renal dialysis services. The proposed base rate is $273.20, which is an increase of $2.18 from the current 2024 base rate of $271.02.
This proposed amount reflects the application of the wage index budget-neutrality adjustment factor and a 2025 proposed productivity-adjusted market basket increase of 1.8%, equaling $273.20.
CMS projects that the updates for 2025 would increase the total payments to all ESRD facilities by 2.2% compared with 2024. For hospital-based ESRD facilities, CMS projects an increase in total payments of 3.9%, and for freestanding facilities, CMS projects an increase in total payments of 2.1%.
THE LARGER TREND
The proposed rule also includes a proposed change to the methodology for calculating the ESRD facility wage index, proposed changes to the Low-Volume Payment Adjustment (LVPA) methodology and several proposed changes to the ESRD outlier policy.
The ESRD PPS provides a bundled, per-treatment payment to ESRD facilities that includes all renal dialysis services furnished for outpatient maintenance dialysis, including drugs and biological products. Additionally, the bundled payment includes all other renal dialysis items and services that were formerly separately payable under previous payment methodologies.
The bundled payment rate is case mix adjusted for a number of factors relating to patient characteristics. There are also facility-level adjustments for ESRD facilities that have a low patient volume, for facilities in rural areas and for the wage index.
When applicable, the bundled payment rate also includes a training add-on payment adjustment for home and self-dialysis modalities, an outlier payment for high-cost patients, and add-on payment adjustments for certain drugs, equipment, and supplies.
CMS is proposing a new ESRD PPS-specific wage index that would be used to adjust ESRD PPS payment for geographic differences in area wages. This proposed methodology would combine data from the Bureau of Labor Statistics Occupation Employment Wage & Statistics and freestanding ESRD facility cost reports to produce an ESRD PPS-specific wage index for use instead of using the hospital wage index values for each geographic area, which are derived from hospital cost report data.
For more information, see information on the CMS proposed rule.
Email the writer: SMorse@himss.org
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