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End stage renal disease facilities in 2022 can expect a 2.5% payment increase compared to 2021, according to the final rule released by the Centers for Medicare and Medicaid Services.
The final CY 2022 ESRD PPS base rate is $257.90, which is an increase of nearly $5 to the current base rate of $253.13. For hospital-based ESRD facilities, CMS projects an increase in total payments of 3.3%, and, for freestanding facilities, CMS projects an increase in total payments of 2.5%.
But the big news released by CMS on Friday is a new emphasis on payments tied to health equity.
WHY THIS MATTERS
CMS is finalizing changes to the ESRD Treatment Choices Model to test a new payment incentive that rewards ESRD facilities and clinicians who manage dialysis patients for achieving significant improvement in the home dialysis rate and kidney transplant rate for lower-income beneficiaries.
The changes to the ESRD Treatment Choices Model aim to encourage dialysis facilities and healthcare providers to decrease disparities in rates of home dialysis and kidney transplants among patients with lower socioeconomic status.
This makes the model one of the agency’s first CMS Innovation Center models to directly address health equity.
In addition, CMS will give enhanced payments for innovative technologies that represent a substantial clinical improvement relative to existing options. This approval will help ESRD facilities offer an additional option to beneficiaries for home dialysis, which is important especially during the pandemic.
The rule addresses data collection system challenges caused by the public health emergency. No facility will receive a payment reduction under the ESRD Quality Incentive Program for the upcoming year, especially since such payment reductions would have been based on performance during the height of the pandemic in 2020.
THE LARGER TREND
Medicare expects to pay an estimated $8.8 billion to approximately 7,700 ESRD facilities for furnishing renal dialysis services.
CMS said it is taking action to close health equity gaps by providing Medicare patients living with End-Stage Renal Disease greater access to care.
According to CMS Office of Minority Health’s studies on racial, ethnic and socioeconomic factors, disadvantaged people with Medicare have higher rates of ESRD. They are also more likely to experience higher hospital readmissions and costs, as well as more likely to receive in-center hemodialysis (vs. home dialysis). Studies also indicate non-white ESRD patients are less likely to receive pre-ESRD kidney care, become wait-listed for a transplant, or receive a kidney transplant.
Consistent with President Biden’s Executive Order on “Advancing Racial Equity and Support for Underserved Communities through the Federal Government,” CMS is addressing health inequities and improving patient outcomes in the U.S. through improved data collection for better measurement and analysis of disparities across programs and policies.
In response to the proposed rule, CMS received valuable feedback on potential opportunities to collect and leverage diverse sets of data such as race, ethnicity, Medicare/Medicaid dual eligible status, disability status, LGBTQ+ and socioeconomic status, to better measure disparities.
CMS’ proposed rule included several requests for information (RFIs) for the agency to consider as part of its goal to increase access to dialysis treatments at home. Commenters’ responses to the RFIs included specific suggestions for improving Acute Kidney Injury (AKI) payment and the ESRD PPS.
ON THE RECORD
“Today’s final rule is a decisive step to ensure people with Medicare with chronic kidney disease have easy access to quality care and convenient treatment options,” said CMS Administrator Chiquita Brooks-LaSure. “Enabling dialysis providers to offer more dialysis treatment options for Medicare patients will catalyze better health outcomes, greater autonomy and better quality of life for all patients with kidney disease.”
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