In final rule, CMS increases Medicare payments for dialysis facilities to 2.1% for 2024
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Key takeaways:
- CMS is increasing the payment rate for dialysis treatments to 2.1% for 2024, up from 1.6% in the agency’s proposed rule.
- CMS also extended add-on payments for use of new renal drugs and innovative devices.
CMS has released a final rule for the prospective payment system that increases the Medicare bundled payment rate for dialysis treatments by 2.1% in 2024, up from a 1.6% increase proposed in June.
The new base rate will be $271.02 starting Jan. 1.
In response to comments to the proposed rule, CMS said it also included an additional 3 years of coverage for its Payment for Certain New Renal Dialysis Drugs and Biological Products After the Transitional Drug Add-on Payment Adjustment (TDAPA) policy.
“This payment adjustment will be case mix adjusted and set at 65% of estimated expenditure levels for the given renal dialysis drug or biological product in the prior year,” CMS said in a press release. “This policy will provide 5 years of increased payment for certain new renal dialysis drugs and biological products,” which include a payment adjustment under the TDAPA for 2 years, followed by a post-TDAPA payment adjustment for 3 years, CMS said.
‘Deep disappointment’
That adjustment isn’t enough to support use of new biologics and innovative devices, Kidney Care Partners (KCP), a coalition of more than 30 organizations representing dialysis providers, manufacturers, professional associations and patient groups, said in response to the final rule, calling it a “deep disappointment” and saying it does not provide support “to address the workforce shortage crisis that has already resulted in widespread clinic closures and a substantial reduction in dialysis treatment shifts and patient access to care,” the organization said in a press release.
“As a physician, knowing that medications that could significantly improve a patient’s quality of life are just out of reach because of a well-intentioned but ultimately unsuccessful payment policy is heartbreaking,” Daniel E. Weiner, MD, a nephrologist at Tufts Medical Center in Boston, said in the release. “Without reform, dialysis innovations will continue to remain limited, leaving the more than half million people who need dialysis dependent on technology and care that has barely changed in more than 30 years.”
Mahesh Krishnan, MD, chair elect of KCP, said in the release the final rule “offers grossly insufficient reimbursement for vital kidney care services. The reimbursement increase is not enough to address the soaring labor and overhead costs that care providers face. CMS’ failure to include a forecast error adjustment to address incorrect estimates about inflationary costs will worsen access to dialysis care, ultimately harming patients living with ESRD nationwide, particularly people of color and those living in rural areas.”
The forecast error adjustment is one of the recommendations in the Chronic Kidney Disease Improvement in Research and Treatment Act, introduced by U.S. House Reps. Carol Miller, R-W.Va., and Terri Sewell, D-Ala., in August. The legislation proposes an add-on payment to dialysis providers to help cover the increased costs of staffing a clinic if CMS inaccurately calculates the costs of clinic operations in its market basket index, which is used to set the bundled payment rate for dialysis treatments.
“... The Secretary shall compute an adjustment to the annual update of the previous calendar year’s rate to account for forecast error” in the market basket index, which would apply “whenever the difference between the forecasted and actual percentage change in the [end-stage renal disease] market basket index exceeds the threshold of 0.5 percentage points,” the legislation reads.
“Now, more than ever, it is essential that federal lawmakers step up and pass legislation to support our nation’s kidney care community before it is too late,” John P. Butler, KCP chair, said in the release.
The final rule can be downloaded from the Federal Register.
References:
CMS. Calendar year 2024 end-stage renal disease (ESRD) prospective payment system (PPS) final rule (CMS-1782-F). Available at: https://www.cms.gov/newsroom/fact-sheets/calendar-year-2024-end-stage-renal-disease-esrd-prospective-payment-system-pps-final-rule-cms-1782-f#. Published Ont. 27, 2023. Accessed Oct. 31, 2023.
Federal Register. Medicare program: End-stage renal disease prospective payment system, payment for renal dialysis services furnished to individuals with acute kidney injury, end-stage renal disease quality incentive program, and end-stage renal disease treatment choices model. Available at: https://www.federalregister.gov/public-inspection/2023-23915/medicare-program-end-stage-renal-disease-prospective-payment-system-payment-for-renal-dialysis.
Kidney Care Partners disappointed with final ESRD prospective payment system rule. https://kidneycarepartners.org/press/kidney-care-partners-disappointed-with-final-esrd-prospective-payment-system-rule/. Published Oct. 30, 2023. Accessed Oct. 30, 2023.
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