On March 14, the Medicare Payment Advisory Commission (MedPAC) released the March 2014 "Report to the Congress: Medicare Payment Policy." Every year, MedPAC assesses payment adequacy for Medicare fee-for-service programs, including outpatient dialysis services, and makes recommendations to Congress.  This year, MedPAC recommended that Congress should not increase the outpatient dialysis bundled payment rate for calendar year 2015.

In their chapter on outpatient dialysis, MedPAC also highlighted the following three concerns:

  1. Bundled payments create an incentive for dialysis providers to furnish fewer services than medically necessary, according to the report. The ESRD QIP in 2013 and beyond does not assess the outcomes associated with pooreranemia management that might occur when fewer services are provided.
  2. The low-volume payment adjustment is not targeting dialysis facilities that might be critical to beneficiary access.
  3. CMS has not yet examined the appropriateness of the costs that dialysis facilities include on their cost reports.

MedPAC addressed the concerns with the following recommendations:

  • Congress should instruct the secretary to:
  1. Include a measure that assesses poor outcomes related to anemia in the End-Stage Renal Disease Quality Incentive Program.
  2. Re-design the low-volume adjustment to consider a low-volume facility’s distance to the nearest facility; and
  3. Audit dialysis facilities’ cost reports.

Click here to download Chapter 6 of the report, which focuses on outpatient dialysis services.

Source: March 21 issue of the National Renal Administrators Association's Renal Watch