End-stage renal disease facilities to get additional $80 million in updated CMS payments

Total payments to all to the end-stage renal disease facilities will increase by .73 percent in 2017, an additional expenditure of $80 million over 2016, the Centers for Medicare and Medicaid Services said Friday.

For hospital-based facilities, CMS projects a payment increase of 0.9 percent, while for freestanding facilities, the projected increase is 0.7 percent. 

Outlier end-stage renal disease facilities may be eligible for  payments for high-cost patients. For 2017, Medicare expects to pay $9 billion to approximately 6,000 facilities for the costs associated with furnishing chronic maintenance dialysis services.

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The new base rate in the end-stage renal disease prospective payment system is $231.55, an increase of $1.16 from the 2016 rate of $230.39. The amount reflects budget-neutrality adjustment factors and the payments will account for wage level differences in various areas. 

However, end-stage renal disease facilities that do not meet or exceed minimum total performance scores will see a reduction of up to two percent in the quality incentive program, CMS said.

Bundled payments include all renal dialysis services furnished for outpatient maintenance dialysis, including drugs and biologicals (with the exception of oral-only drugs until 2025) and other renal dialysis items and services that were formerly paid separately  under previous payment methodologies. 

The bundled payment rate is adjusted for a number of factors including patient characteristics, low patient volume, rural locality, and wage differences. 

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Drugs, biologicals, laboratory services, and supplies that end-stage renal disease facilities furnish, but that are not renal dialysis services, may be paid for separately when given to individuals with acute kidney injury, CMS said.

CMS is also finalizing an update to the outlier services fixed-dollar loss amounts and Medicare allowable payments for adult and pediatric patients.

The fixed-dollar loss amount for pediatric beneficiaries will increase from $62.19 to $68.49, and the Medicare allowable payments amount will decrease from $39.20 to $38.29, compared to 2016. 

For adult beneficiaries, the fixed-dollar loss amount will decrease from $86.97 to $82.92 and the Medicare allowable payments amount will decrease from $50.81 to $45.

CMS is also finalizing an increase to the home and self-dialysis training add-on payment adjustment. Using an updated RN hourly wage of $35.94, and an increase to the hours of nurse training time from 1.5 to 2.66 hours, the 2017 home and self-dialysis training payment is $95.60, an increase of $45.44 from the current amount of $50.16.

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There are no changes to quality incentive payments for 2018. The measures, finalized in 2016, contain eight clinical measures and three reporting measures.

There are changes to quality incentive program payments in 2019 and 2020 aimed at improving care at dialysis facilities, CMS said.

For 2019, CMS combined the national healthcare safety network dialysis event reporting measure with the existing bloodstream infection clinical measure. Additionally, CMS finalized two changes to the hypercalcemia clinical measure, to ensure it remains aligned with specifications of the National Quality Forum.

The 2020 end-stage renal disease quality incentive program contains eight clinical measures and seven reporting measures.

After receiving public input, CMS is maintaining the scoring methodology for 2019, which is to apportion 75 percent of a facility's score to the clinical measure domain, 15 percent to the safety measure domain, and 10 percent to the reporting measure domain.

Twitter: @SusanJMorse