Renal administrators tell Congress payment increase for dialysis inadequate
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Administrators of independent dialysis clinics said in a letter to Congressional leaders that intervention is needed to avoid staffing cuts because of inadequate Medicare payments.
“I write today to urge Congress to take action to protect access for the vulnerable Medicare beneficiaries that rely on life-sustaining dialysis treatments by addressing the detrimental policies finalized in the [Calendar Year] CY 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) rule and extending the legislative prohibition of including oral-only drugs in the ESRD payment bundle,” Caprice Vanderkolk, MS, RN, BC-NE, president of the Renal Healthcare Association (RHA), wrote in the letter. “Insufficient ESRD PPS rates and the inclusion of oral-only drugs in the ESRD payment bundle will be, simply put, disastrous for our industry and for the patients we care for.”
3% increase
CMS released a final rule in November for the Prospective Payment System (PPS), which sets rates for dialysis treatments, that provides a 3% increase in the bundled payment rate for dialysis facilities, increasing the amount from $257.90 to $265.57 per treatment.
“Congressional intervention is desperately needed to avoid catastrophic cuts that pose especially significant threats to the future survival of many independent dialysis providers,” Vanderkolk wrote. “A mere 3% increase to the base rate for [calendar year] 2023 is woefully inadequate in this time of economic and staffing instability. With absent action from Congress, access to care and the quality of care for individuals relying on Medicare for their dialysis services will be jeopardized.”
The letter was sent to Rep. Nancy Pelosi, D-Calif., Sen. Charles Schumer, D-N.Y., Kevin McCarthy, R-Calif., Sen. Mitch McConnell, R-Ky.
In the letter, Vanderkolk said a recent study commissioned by the organization and completed by Prima Health Analytics “found that [dialysis facilities] have accumulated $1.7 billion in losses over the last 3 years. On average, facilities lost 42% of operating expenses in excess of revenues, totaling $320,000 per facility per year.”
The study was based on cost reports of 23% to 25% of all Medicare-certified freestanding dialysis facilities in the United States, according to the RHA.
“Without relief, the Centers for Medicare and Medicaid Services’ (CMS) rules will threaten the ability of the dialysis provider community to safely care for patients and severely curb access to life-sustaining care for adult and pediatric patients with severe kidney disease on dialysis,” Vanderkolk wrote.
RHA membership consists primarily of small and independent for-profit and not-for-profit providers serving patients in urban, rural, and suburban areas in both freestanding and hospital-based facilities, according to the organization.
Staffing shortage
Vanderkolk said the revenue losses are exacerbated by a staffing shortage that has led to higher costs for salaries.
“Given the public health crisis that continues throughout the U.S. and the severe staffing shortages facing providers, health care providers need adequate funding to continue delivering safe and high-quality dialysis treatment to adults and pediatric patients with ESRD,” Vanderkolk wrote. “Between 2017-2021, direct patient care labor costs per dialysis treatment for all dialysis facilities rose by 10.4% and supply costs per treatment across all dialysis modalities rose by an astonishing 16.2%. These additional costs borne by RHA member facilities are not appropriately accounted for in the ESRD PPS.”
Reference:
RHA urges Congress to take action. www.renalhealthcare.org. Published Dec. 14, 2022. Accessed Dec. 20, 2022.
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