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1 in 3 Dialysis Centers Subject to Medicare Penalties

Cheryl Clark, for HealthLeaders Media, December 16, 2011

Nearly one third of 4,939 U.S. kidney dialysis centers will receive Medicare reimbursement penalties of between 2% and .5% starting Jan. 1 because of poor quality scores in anemia management and/or dialysis adequacy, the Centers for Medicare & Medicaid Services said Thursday.

This is the first time quality scores for dialysis centers have been rated for financial penalties under this program, which was authorized by the Medicare Improvements for Patients and Providers Act of 2008.

Of the centers that scored the worst, about 29 centers will receive a 2% reduction in Medicare payments, about 380 will see a 1.5% reduction, about 296 will be paid 1% less and 819 will see a .5% reduction. An additional 625 facilities will not have a payment reduction because of insufficient data.

Those centers who scored 26 or more points out of a possible 30, 60.1% or  3,413 centers, will receive no payment penalty.

Each facility is now required to "prominently" display its End Stage Renal Disease Quality Incentive Program (ESRD QIP) scores, so consumers and caregivers can see how the center fares.

Kamyar Kalantar-Zadeh, MD, Professor of Medicine, Pediatrics & Epidemiology at UCLA David Geffen School of Medicine, applauded the new penalty scores even though one UCLA facility, Davita Harbor UCLA, is one of those targeted for a .5% reimbursement reduction.

"I am exceptionally for it, and feel that is a needed system long overdue, and may contribute to improving patient outcomes," he said. However, he added  that down the line, CMS should include better measures, such as the percentage of a center's patients who require hospitalization, nutritional status, serum albumin levels, mortality rates, infection rates and patient experience scores.

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