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.
"The ESRD QIP program's overarching goal is the continual improvement of dialysis care provided to Medicare beneficiaries nationwide to drive better outcomes," Patrick Conway, MD, Chief Medical Officer and Director of the CMS Office of Clinical Standards and Quality said in a statement. "The ESRD QIP will evolve over time to include additional measures that promote high quality of care and outcomes."
These scores for each center are listed on Medicare's Dialysis Compare website under the heading "Certificate of Dialysis Center Performance." The score is based on three measures:
- Percentage of patients with hemoglobin less than 10 grams per deciliter (g/dL) (low percentage desired).
- Percentage of patients with hemoglobin greater than 12 g/dL (low percentage desired).
- Percentage of Medicare patients with an average Urea Reduction Ratio (URR) of at least 65 percent (high percentage desired).
Medicare officials said in a statement that these scores were based on a formula that rated performance during 2010, compared with a national performance norm across the U.S. in 2008 or the facility's own performance in 2007.
The total sum of payments that would be withheld during the first year is unknown, officials said. The savings to the Medicare program, however, could be substantial. The federal government picks up the tab for dialysis, medications, hospitalization, lab, and physicians' supplies for at least 453,000 patients who lack private insurance, at an average cost of between $57,639 and $77,506 per patient per year as of 2008, according to the U.S. Renal Data System.
Also, dialysis care is under increasing scrutiny because of widely variable but unacceptably high death rates for people who undergo dialysis. According to data accumulated last year, dialysis patients die at the rate of 20 percent per year.
According to CMS data, the facilities with the poorest scores, which will garner a 2% penalty, include:
- Kidney Center of Sherman Oaks, CA
- New Smyrna Beach Dialysis and Lake Dialysis, Leesburg, FL
- FMC Chicago Dialysis Center and FMC Southside Dialysis Center, Chicago, IL
- FMC Shelbyville, IN
- DCI Corbin Dialysis Clinic, Turfway Dialysis and DCI Danville in Kentucky;
- Davita Slidell Kidney Care in LA
- IDF Garrett Dialysis Center in Oakland, MD.
On Nov. 1, CMS announced that for the FY 2013, the following year, it is dropping the measure that assesses patients with hemoglobin level below 10 g/dL, "because medical evidence does not show that targeting a hemoglobin level of at least 10 g/dL, is the most appropriate treatment for many dialysis patients."
However, for FY 2014, it is adding several other measures such as the center's type of vascular access, which encourages the use of arteriovenous fistulae and discourages the use of catheters because of the high rate of infections and complications associated with catheter use.
Three additional reporting measures will reveal whether the center
- Reports dialysis infection events to the Centers for Disease Control and Prevention's National Healthcare Safety Network
- Surveys patients to learn about their experience of care; and
- Monitors patients for abnormalities in phosphorus and calcium levels.
CMS encourages Medicare patients to discuss these results with their dialysis care team and hopes that this information will help these patients to make informed decisions about their care.
CMS said in a statement that it encourages Medicare patients to discuss these results with their dialysis care team and hopes that this information will help these patients to make informed decisions about their care.