Policy and Politics News

Almost all people with pre-dialysis kidney disease should receive statins according to current guidelines, reports a study appearing in an upcoming issue of the Journal of the American Society of Nephrology.

PHILADELPHIA – New studies show that nephrology fellowships slots are going unfilled, but workforce needs in the future may ultimately be influenced by change based on Medicare’s interest in a more integrated approach to patient care.

Kidney Care Partners and the Kidney Care Council are concerned that the Centers for Medicare & Medicaid Services has decided to continue with its Dialysis Facility Compare Star Rating methodology, according to statements released by the groups.

The Centers for Medicare & Medicaid Services announced Nov. 7 that it has finalized the methodology for its Dialysis Facility Compare Star Rating program and is releasing previews of ratings to individual Medicare-participating dialysis facilities. Dialysis facilities will have 15 days to review their ratings. CMS said it expects to post ratings to Dialysis Facility Compare in January 2015.

Since the completion of the Centers for Medicare and Medicaid Services’ end-stage renal disease (ESRD) demonstration projects, passage of the Affordable Care Act, and announcement of ESRD Seamless Care Organizations (ESCOs) by CMS’ Innovation Center, it seems that ESRD-centered accountable care organizations will be the future model for kidney care of Medicare beneficiaries. Regardless of what you call it—managed care organization, special needs plan, ESCO—balancing quality of health care with costs of health care will continue to be the primary directive for physicians and institutions using integrated care management (ICM) strategies to manage their ESRD patients’ health. The renal community has had previous success with ICM, and these experiences could help to guide our way.

It’s a mixed bag.

In fiscal year 2015, the U.S. Department of Health and Human Services Office of Inspector General will be examining the costs of end-stage renal disease drugs, and how they have changed, as well as review Medicare claims data to assess the extent of questionable billing for unnecessary ambulance transports to dialysis facilities, according to the OIG Work Plan.

Following are excerpts from a statement from CMS on its release of the final rule for the Quality Incentive Program, including for payment year (PY) 2017 and PY 2018, under which payment incentives are applied to dialysis facilities to improve the quality of dialysis care. Under the ESRD QIP, facilities that do not achieve a minimum total performance score with respect to quality measures established in regulation receive a reduction in their payment rates under the ESRD PPS.

On Oct. 31, the Centers for Medicare & Medicaid Services issued a final rule that will update payment policies and rates under the End-Stage Renal Disease Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after Jan. 1, 2015.  This rule also introduces new quality and performance measures to improve the quality of care by outpatient dialysis facilities treating patients with ESRD and implements the Affordable Care Act mandate to use competitive bidding rates for durable medical equipment.

A proposed rule released by the Centers for Medicare & Medicaid Services July 2 projects that the updates in the End-Stage Renal Disease Program’s payment bundle for 2015 would increase payments to dialysis facilities by 0.3% to 0.5%, while rural facilities will receive a decrease of 0.5%. CMS projects that ESRD facilities in Puerto Rico and the Virgin Islands will receive a 3.6% decrease in estimated payments, based on the proposed rule.