Policy and Politics News

The Centers for Medicare & Medicaid Services has announced via the Federal Register that it is expanding the three-year Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport to include Maryland, Delaware, the District of Columbia, North Carolina, West Virginia, and Virginia. The expansion will begin Jan. 1, 2016.

Health care delivery is changing, whether we like it or not. The-fee-for-service environment where quantity, not quality, is rewarded is not sustainable and contributes to fragmented care. In essence, patients are really the only ones accountable for their own care.

The clouds are starting to clear on the Dialysis Facility Compare star rating system. There is still plenty of work needed to make this both a value to patients and satisfy dialysis providers, but some common ground may be emerging.

The Centers for Medicare & Medicaid Services has announced the participants for the Comprehensive ESRD Care (CEC) Model, a new accountable care organization (ACO) model. The CEC Model is designed specifically for beneficiaries with ESRD and builds on experiences from other models and programs with ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program. In 2012, ESRD beneficiaries comprised 1.1% of the Medicare population and accounted for an estimated 5.6% of total Medicare spending.

The University of Michigan Kidney Epidemiology and Cost Center has released a 207-page report summarizing a two-­day summit held in April aimed at improving the star rating system for dialysis clinics.

For the Dialysis Facility Compare Star Rating program, the Centers for Medicare & Medicaid Services applies a methodology based on nine publicly reported quality measures to produce a summary star rating for dialysis facilities. The system assigns one to five stars to dialysis facilities by comparing the quality measure outcomes to other dialysis facilities across the country.

October is near the end of the hurricane season in the southern and eastern portions of the United States. Efficient emergency preparedness planning is vital to ensure the safety and vitality of the End Stage Renal Disease (ESRD) and dialysis Community. Part of this emergency preparedness is being able to communicate effectively during a disaster.

On Oct. 7, 2015, CMS held a National Provider Call to review what it had learned in the last 10 months about its Dialysis Facility Compare rating system, including conclusions from a report developed by a technical expert panel that met in April to discuss ways to make it better. On Oct. 8, CMS released its yearly “refresh” of the ratings for the more than 5,000 dialysis facilities across the country.

Editor’s note: This article was originally published Sept. 3 on Home Dialysis Central’s KidneyViews blog. 

Back in the day, nursing homes were primarily for those too ill to be at home or who had no family. This was also before such a thing as same-day surgery and when hospital stays were measured in weeks, not hours. A patient undergoing surgery checked into the hospital the night before and expected to stay until completely well. After discharge, it was not unusual for the physician to stop by the house to check on the patient (think Marcus Welby).