CMS releases final rule on payments for dialysis care
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Providers will receive $265.57 per treatment for patients on dialysis in outpatient facilities starting in January, according to CMS.
In a review of the final Medicare rule covering payment and policies for the End-Stage Renal Disease Prospective Payment System (PPS), the Renal Healthcare Association (RHA) said the payment represents an increase of $1.48 above the proposed calendar year (CY) 2023 base rate and $7.67 above the CY 2022 base rate of $257.90.
“This amount reflects the application of the wage index budget-neutrality adjustment factor (0.999730) and a productivity-adjusted market basket increase of 3%, an increase from the 2.4% as proposed,” the RHA said.
CMS projects that the updates for CY 2023 will increase the total payments to all ESRD outpatient and hospital-based ESRD facilities by 3.1% compared with CY 2022, according to a fact sheet on the final rule, and will pay $7.9 billion to approximately 7,800 ESRD facilities for furnishing renal dialysis services.
CMS also summarized comments in the final rule on several topics that it had requested input from the kidney community, including a potential add-on payment adjustment for certain new renal dialysis drugs and biological products and discussion on health equity issues under the ESRD PPS, with a focus on pediatric dialysis payment.
“The responses to the requests for information will help CMS identify ways to align resource use with payment and ensure that Medicare beneficiaries with ESRD have continued access to technologies that can improve health outcomes and quality of life,” CMS said in a fact sheet on the final rule.
The agency said it also redefined oral-only drugs included in the ESRD payment bundle, beginning Jan. 1, 2025, to include the word “functional” in the description.
“Specifically, under the revised definition, an oral-only drug is a drug or biological product with no injectable functional equivalent or other form of administration other than an oral form,” CMS said.
The agency is also clarifying the descriptions of the ESRD PPS functional categories. “These changes will help ensure that CMS policies are appropriately supporting innovation for new drugs that are truly innovative and not simply minor variations of existing drugs,” according to the fact sheet.
Three new transitional add-on payment adjustments for new and innovative equipment and supplies applications are also in the final rule, along with a change to the ESRD PPS outlier methodology for calculating the fixed-dollar loss amounts for adult patients.
The final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/2022-23778/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis.
Perspective
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Kidney Care Partners, a non-profit coalition of more than 30 organizations representing patients, dialysis professionals, physicians, nurses, researchers, therapeutic innovators, transplant coordinators and manufacturers, appreciates that CMS updated the payment rate for dialysis providers in the 2023 PPS final rule. Unfortunately, the rate increase does not address the major barriers created by the labor crisis facing the entire kidney care community.
Whether you are a patient, health care professional, pharmaceutical or device manufacturer or dialysis provider, the stability and sustainability of the Medicare payment system is essential to provide high-quality, innovative care to those individuals who require dialysis either in facilities or at home. A system that does not have the flexibility to address the unprecedented workforce crisis places patients and the entire community at risk.
A 3% update does not offset the more than 8%-plus increase in workforce costs that federal data indicate have occurred in the last year. Kidney Care Partners (KCP) members are disappointed that CMS did not provide an interim fix to this larger problem by adjusting the base rate to address previous inaccurate estimates in the forecast of the ESRD updates during the past several years as KCP had requested.
It is also imperative that the Medicare rates recognize the dire situation to support quality care for individuals with kidney failure who require life-sustaining dialysis treatments. We hope to work with the agency in the coming weeks to find an immediate solution to this problem.
Lastly, we are pleased that CMS sought comments on removing barriers to the long-term adoption of innovative products in the proposed rule. We strongly encourage CMS to propose a policy based on the comments it received related to an add-on for new products that would come within a functional category after its Transitional Drug Add-on Payment Adjustment ends.
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