Medicare to bundle payments for end-stage renal care, reward quality

Jul 28 2010

Modern Healthcare: Medicare payment for end-stage renal disease care may soon be tied to performance and quality measures if a new proposed rule issued by the Centers for Medicare and Medicaid Services is finalized. "If the rule is finalized, ESRD providers that do not meet set standards" - two measures for anemia management and one for hemodialysis quality - "could have their Medicare payments lowered by up to 2 percent starting January 2012, the CMS said" (McKinney, 7/26).

The Hill: Under a related final rule that was also issued Monday, payments for dialysis treatments, supplies, drugs and tests would be bundled into a lump sum beginning Jan. 1. Newly appointed CMS administrator Donald Berwick said, "The new payment system and quality incentive program for dialysis services have significant potential to improve patient outcomes and promote efficient delivery of health care services. … In addition, for the first time in any of our payment systems, the quality of care facilities furnish to patients will be reflected in their payment rates" (Pecquet, 7/26).

The New York Times: The final regulations would also further curtail the use of anemia drugs under Medicare, such as Amgen's Epogen. "However, after getting lots of protest, Medicare decided to exempt certain oral drugs from the new system until 2014, which could be good news for Genzyme. … Under the new system, the Centers for Medicare and Medicaid Services will pay a set fee for each dialysis treatment. That so-called bundled payment is supposed to cover both the dialysis service, in which wastes are removed from the body, and the drugs and laboratory tests that accompany it. The new system starts phasing in on Jan. 1" (Pollack, 7/26).