CMS wants to reward dialysis providers for improving home dialysis among low-income beneficiaries

Kidney care
The Centers for Medicare & Medicaid Services wants to ensure low-income beneficiaries are able to get access to home dialysis and transplantation and so is aiming to reward providers who improve such access. (Getty/Trish233)

The Biden administration wants to reward providers that improve rates of home dialysis and kidney transplants among low-income Medicare and dual-eligible beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule Thursday that updates payment rates for the End-Stage Renal Disease (ESRD) Prospective Payment System and makes changes to the quality incentive program and ESRD Treatment Choices Model. The goal of the changes is to encourage dialysis providers to decrease disparities in home dialysis and transplant rates, part of a larger effort by the Biden administration.

“Today’s proposed rule is grounded in measures to ensure people with Medicare who suffer from chronic kidney disease have easy access to quality care and convenient treatment options,” said CMS Administrator Chiquita Brooks-LaSure in a statement Thursday.

The agency is proposing to pay $8.9 billion for calendar year 2022 to ESRD facilities for dialysis services. The base payment rate will be $255.55, an increase of $2.42 to the current rate, CMS said in a fact sheet.

This will result in a 1.2% increase for all total payments compared to 2021. Hospital-based dialysis facilities will get a projected 1.3% decrease and a 1.2% hike for any free-standing facilities.

CMS also outlined a new base payment rate for providers that offer renal dialysis services to beneficiaries with acute kidney injury. The agency wants to make the payment rate the same as the base rate for ESRD of $255.55.

RELATED: CVS, Anthem, Intermountain form coalition to push for regulatory changes for home dialysis

The agency also is making several changes to the mandatory payment model ESRD Treatment Choices, which can lower or raise Medicare payments based on rates of home dialysis and transplants.

The model began in January and is set to run through 2027.

CMS is proposing to add health and socioeconomic disparities to the model. The incentives aim to reduce care disparities for lower-income dialysis patients that can access alternatives to dialysis in a facility.

“While people from all backgrounds can be diagnosed with ESRD, it is more common in minority and low-income populations,” a fact sheet on the proposed rule said.

The agency wants to add a new Health Equity Incentive to the improvement scoring methodology that can determine the rates for home dialysis and transplants. Those rates will impact the payment levels that providers in the model can receive.

Participants that choose to add the incentive that have “significant improvements in rates of home dialysis or transplantation” among dual-eligible Medicare and Medicaid or low-income recipients can get additional improvement points.

RELATED: Aetna, Fresenius partner on value-based kidney care for Medicare Advantage members

The agency also wants to stratify the achievement benchmarks for beneficiaries that are dual-eligible or low-income recipients. This move will ensure participants that “see a high volume of these patients would not face negative financial consequences as a result,” the fact sheet said.

CMS proposed making several changes to the ESRD Quality Incentive Program that can reduce payments to providers that don’t meet certain quality metrics.

Key changes outlined in the rule include:

  • Giving facilities more time to report data from September 2020 to December 2020. The facilities now have until Sept. 1, 2021, to report those data.
  • Proposing to suppress use of several quality metrics that ensures facilities aren’t penalized due to circumstances caused by the pandemic. These measures include the Standardized Readmission Ratio and the Standardized Hospitalization Ratio. CMS said that the pandemic “significantly affected the validity and reliability of the measure and resulting performance scores.
  • Using performance standards for the 2024 performance year based on 2019 data instead of 2020. The data from 2020 need to be excluded, because CMS did not consider several metrics because of the pandemic.

In addition to the proposed changes, CMS is issuing a request for information on several topics. These include whether to add two COVID-19 vaccine measures to the quality improvement program that evaluates vaccine coverage among patients and healthcare personnel.

Another proposal is whether to require collection of a minimum set of demographic data elements by facilities for patient admissions. It also wants more information on what racial equity measures could be added to the ESRD Quality Improvement Program.