CMS Issues Payment Rule, Quality Incentive for Dialysis Providers

Dialysis services for nearly 330,000 Medicare patients with end stage renal disease will be paid under a new system that creates a bundled, case-adjusted rate starting Jan. 1, the Centers for Medicare & Medicaid Services announced Monday with its final rule.

In addition, the agency proposed a rule that would create a new Quality Incentive Program (QIP) for dialysis services—the first pay for performance program in fee-for-service—that will link a facility’s payment to how well it meets new performance standards.  The QIP will take effect on Jan. 1, 2012.

About 600 hospital-based and 4,330 free-standing end-stage renal disease facilities are affected.  In 2007, the value of these services was $9.2 billion for dialysis treatments and other related services such as medication.

“The new payment system and quality incentive program for dialysis services have significant potential to improve patient outcomes and promote efficient delivery of healthcare services,” says CMS’ new Administrator Donald Berwick, MD.

“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.” He added, the QIP “is a critical tool for encouraging and supporting dialysis facilities to focus their energies thoroughly on the quality of dialysis care they provide to Medicare beneficiaries.” 

The new payment system provides an adjustment to help patients learn skills to receive dialysis at home if appropriate.