Thank you for your great advocacy! On Friday April 1, the Centers for Medicare and Medicaid Services (CMS) announced their proposal to fix the transition adjustment rate to dialysis providers’ reimbursement under the new Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS also known as the Bundle).

The rule revises the initial rate of 3.1% down to a rate of 0% effective April 1 through December 31, 2011. This means that no further cuts will be made to dialysis care and those cuts that were implemented after April 1 will be returned to dialysis providers.  DPC sent a big thank you to CMS for the adjustment.
>Read the Full Comment Letter

On February 2, 2011 American Kidney Fund, Dialysis Patient Citizens, National Kidney Foundation and Renal Support Network sent a joint letter to Congress requesting a fix to the calculation of the transition adjuster that will be applied to the new bundled payment system in 2011.
>Patient Letter on Transition

Here is some additional background on the issue:

• Congress recently passed a new Medicare bundled payment system for dialysis care. Dialysis providers were given the opportunity either to fully opt in to the new payment system that began January 1, 2011, or to transition into it by 2014. To meet their requirement that no extra money be spent on kidney care than would have otherwise been spent, CMS implemented an “adjustment” in payment to dialysis clinics based on how many facilities it estimated would accept the new payment that began in January. However, this estimation was incorrect and could take away money from dialysis care as a result. 
   
• CMS estimated that only 43 percent of facilities would opt in to the bundle system. Now, CMS says the number is really closer to 85 percent of all dialysis facilities have opted in. This incorrect estimation means that the payment adjustment from CMS could result in nearly $250 million being cut from dialysis care in 2011, unless a re-adjustment is made.
   
• If this transition adjustment discrepancy is not corrected, there could be several negative implications for care:

• Reimbursement cuts could prevent dialysis facilities’ ability to recruit and retain highly trained care teams, including nephrology nurses, technicians, dietitians and social workers.

• Reimbursement cuts could lead to worsened patient to staff ratios.
   
• Expectations for dialysis providers to do more with less could eventually lead to a consolidation of clinics and a reduction in patient access to care.