Policy and Politics News

The Centers for Medicare & Medicaid Services has begun processing claims rejected earlier this month due to an error code in its Outpatient Prospective Payment System, but dialysis providers won’t see all the delayed payments until next month.

After reviewing more than 4,000 comments, the Centers for Medicare & Medicaid Services released the final rule Oct. 14 for the Medicare Access and CHIP Reauthorization Act, the Medicare payment system that replaces the sustainable growth rate formula for physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.

Why do American dialysis patients, living in the most scientifically advanced and prosperous country in the world, still face a double-digit risk of death? While mortality rates have declined among the prevalent population, 17% of patients still die each year, and half will die in less than four years. One out of five deaths will be from deliberate withdrawals from dialysis, according to U.S. Renal Data System data (2015).

An update to the Centers for Medicare & Medicaid Services’ Outpatient Prospective Payment System (OPPS) has led to an error code that rejects claims to dialysis providers.

A bill that would allow dialysis providers to build their own integrated care networks has run into opposition from some of the smaller dialysis companies who say the legislation favors large providers and would limit patient choice.

Legislation introduced in Congress earlier this year (H.R. 5942, H.R. 5506 and S. 3090), would establish a 5-year voluntary Medicare demonstration model to integrate care for patients with end-stage renal disease (ESRD). This is separate from, and in addition to, the current ESRD Seamless Care Organization (ESCO) model that the Centers for Medicare & Medicaid Services (CMS) Innovation Center has been running since October 2015. The Dialysis PATIENTS Demonstration Act would allow Medicare-eligible dialysis providers to set up independent, integrated care networks.

A group of five, well-respected biomedical researchers emphasized the importance of providing better care to high-need, high-cost patients in a recent paper published in the New England Journal of Medicine.1 Those diagnosed with end-stage renal disease (ESRD) fit that description precisely, as they require some of the most complex and costly care of any patient population in the United States. Importantly, however, care delivery improvements have been shown to significantly impact quality outcomes, conserve resources, and could serve as models for innovation in in caring for other chronic conditions.

A proposal to bundle Medicare codes that set reimbursement for interventional dialysis procedures could cut revenue for access centers by up to 40%, industry officials say.

On Sept. 22, Representatives Michael C. Burgess, MD, R-Texas, and Ron Kind, D-Wisc., introduced the Immunosuppressive Drug Coverage for Kidney Transplant Patients Act. This legislation would allow individuals who are eligible for immunosuppressive drugs under Medicare Part B to continue to receive their treatment past the current 36-month cutoff.

The U.S. House has passed the ESRD Choice Act of 2016 (H.R. 5659). The bill, introduced in July by Representatives Jason Smith, R-Mo., John Lewis, D-Ga., Gus Bilirakis, R-Fla., Kurt Schrader, D-Ore., and Tom Marino, R-Pa., would remove current government rules and restrictions that prevent end-stage renal disease patients from participating in Medicare Advantage plans.