End-Stage Renal Disease Proposed 2018 Policy and Payment Rate Changes

July 2017 ~

CMS has issued a proposed rule that would update payment policies for the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS).

According to CMS the ESRD PPS proposed rule is one of several for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

“CMS is committed to transforming healthcare to empower patients and doctors so that they can make the best decisions about their health,” said CMS Administrator Seema Verma in a CMS press release. “A focus on patient-centered care allows providers to direct their time and resources to improving health outcomes for all patients rather than complying with burdensome regulations from Washington, D.C.”

The rule covers payment rates for renal dialysis services furnished to beneficiaries on or after January 1, 2018. Key changes under the ESRD PPS proposed rule include:

  • A 0.7% rate update, which reflects a projected 2.2% market basket increase that is offset by a 1% reduction under the Protecting Access to Medicare Act (PAMA) and a 0.5% multifactor productivity reduction;
  • Update outlier fixed dollar loss amounts and Medicare Allowable Payments;
  • Allowing the use of any pricing methodology under section 1847A of the Social Security Act to determine the cost of drugs and biologicals when average sales price (ASP) data is not available for outlier payment purposes;
  • Setting the acute kidney injury (AKI) dialysis rate to equal the proposed ESRD PPS base rate;
  • changes to its ESRD Quality Incentive Program (QIP) quality measures and methodologies for payment years 2019 – 2021; and
  • A “Request for Information on Medicare Flexibilities and Efficiencies” that invites suggestions for ways to “increase quality of care, lower costs, improve program integrity, and make the health care system more effective, simple and accessible.”

CMS says the payment incentives implemented under the proposed rule focus on improved quality of care at dialysis facilities, ensure program stability, and will build patient-centered system of care to increase competition. CMS anticipates that the proposed rule would increase total Medicare payments to ESRD facilities by 0.8% in 2018, with hospital-based ESRD facilities having an estimated 1.0% increase and freestanding facilities having an estimated 0.8% increase.

CMS will accept comments on the proposed rule until August 28, 2017.

For More information, refer to ESRD Fact Sheet or visit the ESRD Center webpage.


Source(s): CMS MLN Connects; CMS Press Release; CMS Fact Sheet; Federal Register;