Medicare drops end-stage kidney disease payment rule aimed at closing health equity gaps

The Biden administration on Friday dropped a final rule that will reward providers who improve rates of home dialysis and kidney transplants among low-income, dual-eligible Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) finalized a rule which updates payment rates for the End-stage Renal Disease (ESRD) Prospective Payment System and makes changes to the Quality Incentive Program and ESRD Treatment Choice Model. The goal of the changes is to encourage dialysis providers to reduce disparities in dialysis and home transplant rates, as part of a larger effort by the Biden administration.

It is the first CMS innovation center model to directly address health equity.

“Today’s final rule is a decisive step in ensuring that medicare people with chronic kidney disease have easy access to quality care and convenient treatment options,” said CMS administrator Chiquita Brooks-LaSure said in a statement. “Enabling dialysis providers to offer more dialysis treatment options to Medicare patients will catalyze better health outcomes, greater independence and a better quality of life for all patients with kidney disease. ”

According to studies by the CMS Office of Minority Health on racial, ethnic and socio-economic factors, disadvantaged people with Medicare have higher rates of ESRD. They are also more likely to experience hospital readmissions and higher costs, as well as more likely to receive in-center hemodialysis (compared to home dialysis). Studies also indicate that patients with non-white ESRD are less likely to receive pre-ESRD kidney care, be put on a transplant wait list, or receive a kidney transplant.

RELATED: CMS Wants To Reward Dialysis Providers For Improving Home Dialysis Among Low Income Beneficiaries

The end-stage renal disease payment model rule also includes small payment increases for dialysis facilities, including 2.5% for hospitals and 3.3% for independent providers.

The total increases represent an estimated overall increase of 2.5% from 2021, CMS said.

CMS improves access to home dialysis for patients from all socio-economic backgrounds. Agency finalizes changes to ESRD Treatment Choices (ETC) model to test new payment incentive that rewards ESRD facilities and clinicians who manage dialysis patients for significantly improving home dialysis rate and rate kidney transplant for low-income recipients.

CMS is also approving the very first technology under a recently established policy that allows enhanced payments for innovative technologies that represent a substantial clinical improvement over existing options, agency officials said. This approval will help ESRD facilities provide an additional option to beneficiaries for home dialysis during this critical time of the pandemic.

Under the 2022 Prospective Payment System for ESRDMedicare expects to pay approximately $ 8.8 billion to approximately 7,700 ESRD facilities to provide kidney dialysis services. The final base rate for the 2022 ESRD PPS is $ 257.90, which is an increase of nearly $ 5 from the current base rate of $ 253.13, the agency said.

RELATED: CVS, Anthem, and Intermountain Form Coalition to Lobby for Regulatory Changes for Home Dialysis

In line with President Biden’s executive order on “Promoting Racial Equity and Supporting Underserved Communities Through the Federal Government,” CMS is addressing health inequalities and improving patient outcomes in the United States. United through better data collection for better measurement and analysis of disparities between programs and policies. In response to the proposed rule, CMS received valuable feedback on potential opportunities to collect and exploit various datasets such as race, ethnicity, dual Medicare / Medicaid eligibility status, disability status , LGBTQ + and socio-economic status, in order to better measure disparities.

CMS also received feedback on various methodical approaches to advancing equity through the ESRD Quality Incentive Program (ESRD QIP).

The rule finalizes the ESRD PAQ policies that address the circumstances of the COVID-19 public health emergency and the functionality challenges of implementing a new data collection system. These challenges include a special scoring and payment policy under which no facility will receive a payment reduction under the ESRD PAQ for the coming year, especially since these payment reductions would have been based on performance at the height of the pandemic in 2020, CMS said.

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About Matthew R. Dailey

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