More than 5,000 dialysis centers around the country would have to work within much stricter quality guidelines under Medicare's proposed incentive payment program for care delivered to patients with end-stage renal disease.
Included in the proposal is that each center's rate of hospital admissions—the adjusted number of patients who required admission to a hospital because of an infection or other adverse event—would be publicly reported in 2015 "to encourage facilities to improve their care."
Several other quality measures would be folded into a formula that determines reimbursement of federal funds to dialysis centers, which now treat more than 547,000 patients with renal disease who undergo dialysis, a cost to Medicare estimated at $8.7 billion for 2013, and $39.46 billion in public and private (insurance and patients' co-payments) spending as of 2008.
The proposed rule states that these measures were picked in the belief that they "are important indicators of patient outcomes and quality of care."
"Poor management of anemia and inadequate dialysis, for example, can lead to avoidable hospitalizations, decreased quality of life, and death. Infections are also a leading cause of death and hospitalization among hemodialysis patients, but there are proven infection control methods that have been shown effective in reducing morbidity and mortality," the rule states.
The new measures include:
- Reporting to the Centers for Disease Control and Prevention's National Healthcare Safety Network of events such as infections.
- A measure for evaluating how well dialysis centers manage patients' anemia, which can be an unintended consequence of treatment.
- A survey administered by a third party to gauge patients' experiences as they undergo treatment, similar to Medicare's HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey.
- Clinical quality of care, in which the centers are evaluated based on whether the centers achieve in their patients hemoglobin levels greater than 12 g/dL; hemodialysis adequacy based on urea reduction ratios; whether they receive the most effective type of vascular access; and whether patients are monitored for phosphorous and calcium level abnormalities.
"We believe that the policies and rate changes proposed today will continue to help ensure that beneficiaries diagnosed with ESRD continue to get the care they need," said Jonathan Blum, deputy administrator and director of the Centers for Medicare & Medicaid Services Center for Medicare.
In all, the proposed Quality Incentive Program (QIP) includes 11 measures, which Patrick Conway, MD, CMS' chief medical officer and director of the agency's Office of Clinical Standards and Quality, says are "essential for patient-centered care, including anemia management, preventing bloodstream infections, dialysis access and adequacy and patient experience."
Dialysis center care is high risk and intense, and more than one in five patients who undergo the treatments die each year, many of them while awaiting a transplant. Many more require expensive hospitalizations to deal with preventable infections and other problems the treatment causes.
The 176-page proposal also includes payment changes for centers receiving bundled payments, with certain exclusions and inclusions for various medication treatments these patients require.
The Centers for Medicare & Medicaid Services also expanded the requirement that each dialysis center post its quality of care score by saying the signs must be in both English as well as Spanish.
CMS says it will accept comments until August 31.