
CMS Seeks Incentives for At-Home Dialysis in Wake of COVID-19
End-stage renal disease has long been one of the most expensive and debilitating conditions that affects Medicare beneficiaries. Not only does dialysis cost $90,000 a year—those awaiting a kidney transplant automatically qualify for Medicare—but the need to travel to a dialysis center multiple times a week disrupts employment and home life.
CMS said Monday it planned to pay more for dialysis equipment used at home, with the aim of moving more treatment outside dialysis centers while the nation grapples with the coronavirus disease 2019 (COVID-19) pandemic.
In a statement, CMS said that the “transitional add-on payment for new and innovative equipment and supplies,” or TPNIES, would allow greater access to home dialysis machines, making it easier to get them to Medicare beneficiaries.
The proposed 235-page rule, published in the
ESRD has long been one of the most expensive and debilitating conditions that affects Medicare beneficiaries. Not only does
A year ago this week, President Donald Trump outlined key goals for renal care in an executive order, and HHS Secretary Alex Azar unveiled
Getting these concepts to the point of a federal rulemaking proved challenging, however. Dialysis industry leaders challenged the
Then came COVID-19. ESRD patients were landing in the hospital in high numbers, and they didn’t fare well once they got there.
“CMS data shows that those with ESRD have the highest rate of hospitalization of any single group, a trend consistent with having to frequently leave home to receive dialysis,” Administrator Seema Verma said
COVID-19 can also cause
“Today’s action represents a sorely needed course direction, making it easier for ESRD facilities to make new and innovative home dialysis machines available to patients who need them,” Verma said.
A
The fact sheet outlines several other payment changes, including:
- increasing base rates for care for ESRD, known as the prospective payment system (PPS),
- adding a payment to train patients to use home dialysis,
- making adjustments for high-cost patients and for dialysis facilities that are typically low volume, but are higher volume right now due to COVID-19,
- folding the cost of ESRD drugs called calcimimetics into the ESRD PPS bundled payment, which will help Medicare Advantage plans, and
- adjusting the wage index under the ESRD prospective payment system, which adjusts wages based on differences in local labor markets. However, decreases would be capped the first year.
In the fact sheet, CMS projects that the net result of the change, which would take effect January 1, 2021, will increase the total payments to all ESRD facilities and to freestanding facilities by 1.6% percent compared with calendar year 2020. For hospital-based ESRD facilities, CMS expected total payments to fall by 0.4% compared with calendar year 2020.
A coalition of 34 kidney care and advocacy organizations,
CMS also said it has proposed adjustments to payment model reforms made under last year’s rule changes:
ESRD Quality Improvement Program. In this program CMS evaluates the entire facility on measures specific to a given payment year and reduces payments when the facility fails to meet preset benchmarks, or a total performance score. CMS also publicly reports the results. Under changes proposals for 2023 an 2024, a key measure—the ultrafiltration rate—would be based on patient months instead of facility months, which aligns more closely with outcomes based measures.
National Healthcare Safety Network Validation Study. To ease burdens on facilities, CMS will allow 20 records from any 2 quarters instead of 20 records from each of the first 2 quarters.
Newsletter
Stay ahead of policy, cost, and value—subscribe to AJMC for expert insights at the intersection of clinical care and health economics.