It is a move that is supported by a December 2012 report from the Government Accountability Office. According to the report, the utilization of ESRD drugs in 2011 was about 23% lower, on average, than it was in 2007.
As a result, the GAO said Medicare may have paid more than necessary for dialysis care in 2011 because the bundled payment rate in that year was based on 2007 utilization levels. The GAO estimated that a rebase to 2011 would have saved between $650 million and $880 million in 2011.
Advocates contend that the ESRD program has already absorbed more than its share of cuts, including a 2% reduction in overall payments when the ESRD bundled payment system was implemented in 2011.
The immediate concern is that the ERSD payment will be reduced so much that the cost of delivering dialysis will exceed reimbursement for the service. That could mean fewer dialysis clinics will be in business and patient access could be limited, especially in rural and inner city areas.
Over the long-term there's concern that another reduction in payment could affect industry innovation by further limiting the ability of providers to invest in advanced therapies, says Tonya Saffer, senior federal health policy director, for the National Kidney Foundation in Washington D.C.