Most dialysis costs are covered by Medicare regardless of the age of the patient. Since Medicare reimburses for the majority of dialysis treatments they have rules and standards that dialysis providers must follow to ensure patient health and safety is the ultimate priority for providers.

CMS Debates Coverage for ESAs
On March 16, 2011 in response to a public request, the Centers for Medicare and Medicaid Services (CMS) reviewed its coverage policy for ESA (erythropoietin stimulating agents also known as EPO) use in patients with Chronic Kidney Disease (CKD), including those on dialysis.  CMS stated they are proposing not to issue a National Coverage Determination (NCD) at this time. This means that for now, CMS is proposing to keep existing reimbursement policy in place. This is a positive move for kidney patients because it places no extra barriers for patients and physicians to make decisions about the treatment of anemia.  

Previously DPC was concerned CMS could develop a policy that would further restrict kidney patients’ access to ESAs to treat their anemia. While we believe all patients should be informed of the risks and benefits of ESA use, it is important that payment policies do not interfere with patients and physicians making decisions about the best course of treatment.  We also strongly believe that when federal agencies are reviewing the evidence on benefits and risks of any medication that they should also look at patient self reported quality of life.

Click the links below to read DPC’s letters and testimony to CMS about the importance of ensuring  patients have access to ESAs.
>DPC MEDCAC Comments February 2010
>DPC MEDCAC Comments December 2010
>DPC MEDCAC Outcome Response January 2011

Medicare Releases Proposal on Improving Quality of Care Delivered to Patients with ESRD
In addition to the new bundled payment system beginning in 2011, Medicare will launch a new quality incentive program (QIP) for dialysis facilities.  This program is the first in Medicare that will align payment with the quality of care providers deliver.  Facilities who do not meet Medicare specified quality measures will receive a reduction in reimbursement from Medicare.   On September 24, 2010 DPC sent a letter to Medicare with recommendations to assist Medicare in developing a quality program that will encourage dialysis facilities to improve the quality of care they deliver to patients.
>>Learn more about the QIP

Medicare Rules on Monthly Visits between Doctors and Home Dialysis Patients
On November 2, 2010 the Centers for Medicare and Medicaid Services (CMS) ruled physicians should see home dialysis patients monthly and must do so in order to receive payment.  The rule did allow for local Medicare contractors to waive this requirement on a case by case basis, providing the physician gives appropriate justification or evidence that the patient’s care was appropriately managed during the month.  This ruling by Medicare recognizes the importance for patients to receive appropriate, quality care.

In addition, Medicare made it easier for home visits and pre-dialysis education to take place in rural communities by adding these services to the list of Medicare Telehealth offerings.
Read DPC’s letter to CMS
 

Home Hemodialysis Work Group Adequacy Report Recommendations
DPC joins with other organizations to request CMS use a weekly or standardized Kt/V be used to measure and report dialysis adequacy for home hemodialysis patients.
Recommendations

US Government Accountability Office - Report to Congressional Committees, May 2009
End Stage Renal Disease: CMS should monitor effect of bundled payment on home dialysis utilization rates.
GAO Report

Centers for Medicare and Medicaid Services (CMS) Implementation of the "ESRD Bundle"
As CMS works to implement their new payment system for dialysis care, DPC is following the issue closely and providing advise on the best way to implement the program for patients. CMS is expected to put out a proposed plan also known as a “proposed rule” the public will have an opportunity to comments and DPC will ensure dialysis patients are heard in this process. Learn more about how this issue impacts you by reading our letter to Dr. Barry Straube at CMS. We will send out more information on how you can directly participate in the comment process as soon as the rule is released.
>Read More

Improved Patient Safeguards
On April 3, 2008, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that establishes new Conditions for Coverage (CfCs) that dialysis facilities must meet to be certified under the Medicare program. The final rule reflects advances in dialysis technology and standard care practices since the requirements were first issued in 1976.

Most of these rules go into effect October 14, 2008, but some conditions will not be in
effect until February 2009.

Click here for a summary of the rules that will impact dialysis patients the most.

ESRD Networks
Under the direction of CMS, the End-Stage Renal Disease (ESRD) Network Program consists of a national network of 18 ESRD Networks, responsible for each U.S. state, territory, and the District of Columbia. ESRD Networks service geographic areas based on the number and concentration of ESRD beneficiaries.

ESRD Networks work with consumers and ESRD facilities and other providers of ESRD services to refine care delivery systems to make sure ESRD patients get the right care at the right time. http://www.esrdnetworks.org

The Program's responsibilities include:

• Assuring the effective and efficient administration of benefits
• Improving quality of care for ESRD patients
• Collecting data to measure quality of care
• Providing assistance to ESRD patients and providers
• Evaluating and resolving patient grievances

ESRD Special Study:Delivery of Dialysis Treatment Within the Long-Term Care Facility
The following report conducted by ESRD Networks 9 and 10 provided recommendations to on best practices for providing dialysis services in long-term care facilities.
Best Practices
 

Archived Articles