CMS on Thursday released a proposed payment rule that takes several steps to reduce disparities in care for patients with end-stage renal disease (ESRD), which disproportionately affects people with lower socioeconomic status .
Changes to the ESRD Potential Payments System (PPS) would begin on or after January 1, 2022. The proposed rule would update the ESRD PPS payment rates, make changes to the ESRD Quality Incentive Program (QIP), and change the ESRD Processing Choices (ETC) model.
The proposed changes to the ESRD ETC model would make it the first payment model under the CMS Innovation Center to directly address health equity by pushing for increased rates of home dialysis and kidney transplants.
“The rule proposed today is based on measures to ensure that medicare people with chronic kidney disease have easy access to quality care and convenient treatment options,” CMS administrator Chiquita Brooks-LaSure said in a statement.
Studies have shown that low-income Medicare patients have higher rates of ESRD, are more likely to experience hospital readmissions and higher costs, as well as receive in-center hemodialysis instead of seeing each other. offer home dialysis. In addition, non-white patients are less likely to receive pre-ESRD kidney care, be put on a transplant wait list, or receive a kidney transplant.
In a file, CMS said that under the ESRD PPS for 2022, Medicare would pay $ 8.9 billion to approximately 7,700 ESRD facilities for dialysis services; the base rate is $ 255.55, an increase of $ 2.42 from the current base rate.
Hospital-based ESRD facilities would see a decrease in total payments of 1.3%, and stand-alone facilities would see an expected increase in total payments of 1.2%. Overall there would be a 1.2% increase for all total payments compared to 2021.
CMS also introduced a new base payment rate for providers who offer dialysis for acute kidney injury, setting it at the same base rate for IRT of $ 255.55.
CMS also said it was seeking public comments on the requests for a transitional adjustment of the Supplementary Payment for New and Innovative Equipment and Supplies (TPNIES), as 2 products, a home dialysis machine and a monitoring system for peritoneal dialysis, are under consideration for TPNIES for 2022. CMS is seeking public comments on whether products meet eligibility criteria.
For the ESRD ETC model, which is a mandatory payment model, CMS said it is considering a two-tier approach to reducing disparities through its benchmarking and scoring methodology.
First, a “Health Equity Incentive” would be added to the methodology for scoring improvement for home dialysis rate and transplant rate. Providers who show significant improvement in home dialysis or transplant rates in dual Medicare and Medicaid eligible patients or low income grant (LIS) recipients may earn additional improvement points.
Second, CMS would stratify the success criteria by proportion of dual eligibility recipients or LIS recipients, so that providers with a high volume of such patients would not face negative financial consequences.
CMS stated that “these two proposed changes recognize that socio-economic disparities in access to other renal replacement modalities exist and may impact the ability of ETC participants to perform well in the ETC model, while by encouraging all ETC participants to reduce these disparities between their Medicare. the patients.”
the to reign will be open for public comment after publication in the Federal Register.