CMS Updates Policies and Payment Rates for End-Stage Renal Disease Prospective Payment System (CMS 1651-F)

On October 28, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished beginning January 1, 2017.

Under the ESRD PPS for 2017, Medicare expects to pay approximately $9 billion to approximately 6,000 ESRD facilities to cover dialysis services. The finalized 2017 ESRD base rate will be $231.55. CMS projects that the updates for 2017 will increase total payments to all ESRD facilities by 0.73 percent compared with 2016, amounting to about $80 million. 

CMS is finalizing an increase to the home and self-dialysis training add-on payment adjustment in an effort to promote greater use of home modalities. The 2017 home and self-dialysis training add-on payment adjustment is $95.60, an increase of $45.44 from the current training add-on amount of $50.16.

The ESRD PPS final rule also made changes to the ESRD Quality Incentive Program (QIP) to be reflected in payments made in 2019 and 2020. Under the ESRD QIP, facilities that do not achieve a minimum Total Performance Score receive a reduction in their payment rates under the ESRD PPS. The QIP reduces payments by up to two percent to ESRD facilities that do not meet or exceed the minimum score.

Effective in 2019, a new Safety Measure Domain becomes a third category of QIP measures, weighted at 10 percent. This will include the existing NHSN Bloodstream Infection clinical measure. For 2020 the ESRD QIP measure set contains eight clinical measures and seven reporting measures encompassing anemia management, dialysis adequacy, vascular access type, patient experience of care, infections, mineral metabolism management, safety, pain management, depression management and hospital readmissions. 

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