Dialysis facilities get a proposed 1.6% payment bump for 2024

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CMS is proposing to increase the end stage renal disease prospective payment base rate to $269.99 for 2024, increasing total payments to freestanding ESRD facilities by $4.42, or approximately 1.6% compared to 2023.

For hospital-based ESRD facilities, CMS projects an increase in total payments of 2.6%.

Under the 2024 End Stage Renal Disease Prospective Payment System (ESRD PPS) proposed rule Medicare expects to pay $6.4 billion to approximately 7,800 ESRD facilities for furnishing renal dialysis services. 

The proposed rule is for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024.

WHY THIS MATTERS

The calendar year 2024 End Stage Renal Disease Prospective Payment System proposed rule also includes several proposals and requests for information related to ESRD payment policies. 

First, the rule includes a proposed payment adjustment that would increase payment for certain new renal dialysis drugs and biological products after the Transitional Drug Add-on Payment Adjustment period ends. This proposed increase would help ensure payment is not a barrier to accessing innovative treatments for Medicare ESRD beneficiaries, CMS said.

Additionally, to explore options regarding payment, the proposed rule includes requests for information for the possible creation of a new payment adjustment that would increase payment to geographically isolated ESRD facilities. 

It also requests information to inform potential future rulemaking regarding updates to the Low-Volume Payment Adjustment (LVPA) methodology.

The rule proposes to create certain exceptions to the LVPA attestation process for ESRD facilities affected by disasters and other emergencies. 

Additionally, this rule includes proposals to require reporting of "time on machine" data, the amount of time that a beneficiary spends receiving an in-center hemodialysis treatment, and reporting of discarded and unused amounts of certain renal dialysis drugs and biological products from single-dose containers and single-use packages, on ESRD PPS claims.

This rule also includes a proposed transitional add-on pediatric ESRD dialysis payment adjustment for years 2024, 2025 and 2026, which is expected to promote equitable and accurate payments, since treatment for the pediatric ESRD population tends to be especially complex and costly, CMS said. 

The rule also proposes an update to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year 2024. CMS is proposing to update the Acute Kidney Injury dialysis payment rate for 2024 to equal the ESRD PPS base rate and to apply the CY 2024 wage index. The proposed CY 2024 payment rate is $269.99.

THE LARGER TREND

The proposed rule 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 (with the exception of oral-only ESRD drugs until 2025). 

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.

The proposed wage index changes are based on the latest core-based statistical area (CBSA) delineations and the latest available "pre-reclassified" hospital wage data collected under the Hospital Inpatient Prospective Payment System. 

In addition, the rule proposes to update requirements for the ESRD Quality Incentive Program (QIP).  Under the program, CMS assesses the total performance of each facility on quality measures specified for a payment year, applies an appropriate payment reduction to each facility that does not meet a minimum total performance score and publicly reports the results.

For Payment Year 2026, CMS is proposing to add the Facility Commitment to Health Equity reporting measure to the ESRD QIP measure set; to update the COVID-19 Vaccination Coverage Rate Among Healthcare Personnel (HCP) reporting measure; to convert the Clinical Depression Screening and Follow-Up reporting measure to a clinical measure; to remove the Ultrafiltration Rate reporting measure from the ESRD QIP measure set; and to remove the Standardized Fistula Rate clinical measure from the ESRD QIP measure set.

For Payment Year 2027, CMS is proposing to add the Screening for Social Drivers of Health reporting measure to the ESRD QIP measure set and to add the Screen Positive Rate for Social Drivers of Health reporting measure to the ESRD QIP measure set.
 

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org