CMS Issued a Final Ruling on 2014 Dialysis Payment Rates

As many of you may know, on Nov. 22, the Centers for Medicare & Medicaid Services (CMS) issued its final rule on 2014 payment rates for dialysis facilities paid under the End Stage Renal Disease Prospective Payment System (ESRD PPS) as well as updates to the Quality Incentive Program (QIP). CMS first announced a proposed cut of 12 percent(1) from Medicare’s ESRD program in July, potentially threatening access to dialysis care for thousands of patients with kidney disease across the country.

Thanks to the support from our physician partners, patients, teammates and other members of the kidney care community over the last few months, we were able to generate more than 124,000 contacts to Congress asking them to help stop the cuts. Our combined efforts were a success, resulting in flat rates over the next two years and continued access to dialysis care for our patients. But we still have some work to do to help mitigate future cuts.

Within the 340+ pages of the rule there is clearly good news and bad news; some highlights are described below.

Let’s start with the bad news first.

• The full 12 percent payment reduction—to account for changes in injectable drug use— will still happen over time, despite cogent arguments that changes in drug use did not fully reflect changes in total costs of delivering care due to bundling.
• The proposed QIP measures were left essentially intact despite concerns from the kidney care community and will include a hypercalcemia measure and more frequent administration of the Consumer Assessment of Healthcare Providers and Systems (CAHPS), the latter starting in 2017.

There is some good news as well.

• In 2014 and 2015, the bundled payment will remain flat with 2013, despite the cost of care increasing. The 12 percent cut will be phased in over three to four years.
• Additional administrative approaches to mitigate the 12 percent cut are possible going forward and may minimize the impact of the cuts on access to care for our patients.
• The home dialysis training fee has been increased.

So here’s the bottom line. At a minimum, the can has been kicked down the street, allowing time for the renal community to continue to work with CMS to ensure that patients have full access to care and that facilities have sufficient funding to continue to drive better clinical outcomes and innovation. In addition, it is clear that much additional work is needed to help CMS focus on important clinical outcomes that drive high-quality care and truly improve the lives of patients.

For additional information on the final CMS rule for the ESRD PPS, please refer to the following links:

• CMS Final Rule End Stage Renal Disease Prospective Payment System
• DaVita HealthCare Partners Inc. Comments on the Final CMS ESRD Rates
• CMS retains 12% cut in drug payments for ESRD care, Nephrology News & Issues
• U.S. Medicare program leaves 2014 dialysis payments unchanged, Reuters

You may also reach out to me at OfficeOfTheCMO@davita.com with any specific questions on the ESRD PPS final ruling.

Thank you for your dedication to stop the proposed Medicare cuts and advocate on behalf of our patients for continued access to care.