CMS final rule covering dialysis payments includes incentives to improve equity of care
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CMS released a final rule on Oct. 29 that updates payment rates for dialysis providers and offers financial incentives to improve equity in kidney care.
Changes to the End-Stage Renal Disease Prospective Payment System for kidney dialysis take effect January 1.
Additionally, the rule finalizes modifications to the ESRD Treatment Choices (ETC) Model, which began in January 2021, to encourage certain health care providers to decrease disparities in rates of home dialysis and kidney transplants among patients with ESRD with lower socioeconomic status.
“Today’s final rule is a decisive step to ensure people with Medicare with chronic kidney disease have easy access to quality care and convenient treatment options,” Chiquita Brooks-LaSure, CMS Administrator, said in the release. “Enabling dialysis providers to offer more dialysis treatment options for Medicare patients will catalyze better health outcomes, greater autonomy and better quality of life for all patients with kidney disease.”
Quality Incentive Program
The final rule also updates requirements for the ESRD Quality Incentive Program (QIP), and includes public comments received in response to requests for information on topics that are relevant to the ESRD QIP, including the possibility of a performance measure on vaccination rates for dialysis patients and staff.
Under the ESRD PPS for CY 2022, Medicare expects to pay an estimated $8.8 billion to approximately 7,700 dialysis facilities for furnishing renal dialysis services.
The final ESRD base rate for dialysis treatment will be $257.90 — an increase over the current base rate of $253.13. CMS said it projects that the updates for CY 2022 will increase the total payments to all ESRD facilities by 2.5% compared with 2021.
Equity in kidney care
CMS finalized payment incentives for dialysis facilities participating in the ETC Model. Currently, participating ESRD facilities and clinicians who manage dialysis patients receive positive or negative adjustments on certain claims for dialysis and dialysis-related services based on the home dialysis rate and transplant rate. The Home Dialysis Payment Adjustment (HDPA) provides an upward adjustment on home dialysis and home dialysis-related claims, and the Performance Payment Adjustment (PPA) creates upward or downward performance-based adjustment on dialysis and dialysis-related claims.
To improve equity in dialysis care, changes in the final rule include incentives for participating ESRD facilities and managing clinicians to address health equity among ESRD patients of lower socioeconomic status. CMS added a Health Equity Incentive to the improvement scoring methodology for both the home dialysis rate and the transplant rate. ETC facilities that demonstrate significant improvement in the home dialysis rate or transplant rate among their attributed beneficiaries — who are dual-eligible for Medicare and Medicaid or Low Income Subsidy (LIS) recipients — could earn additional improvement points.
“Taken together, these two changes acknowledge that socioeconomic disparities in access to alternative renal replacement modalities exist and may impact the ability of ETC participants to perform well in the ETC Model, while providing an incentive for all ETC Participants to reduce such disparities among their Medicare patients,” CMS said.
The final rule can be downloaded from the Federal Register here.
References:
CY 2022 End Stage Renal Disease Prospective Payment System Final Rule (CMS-1749-F). https://www.cms.gov/newsroom/fact-sheets/cy-2022-end-stage-renal-disease-prospective-payment-system-final-rule-cms-1749-f Published Oct. 29, 2021; accessed Nov. 1, 2021.
End Stage Renal Disease (ESRD) Prospectice Payment System (PPS).https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment Published Oct. 29, 2021; accessed Nov. 1, 2021.