The Centers for Medicare & Medicaid Services (CMS) will begin implementing a prior authorization demonstration program for non-emergent ambulance transport of dialysis patients in New Jersey, Pennsylvania and South Carolina. CMS believes using a prior authorization process will help ensure services are provided in compliance with Medicare coverage rules, specifically that ambulance providers in those states must obtain documentation from physicians prior to the beginning of service. The requirement does not apply to hospital-based ambulances.
Today, Dialysis Patient Citizens received a notice from CMS announcing a three-month delay in implementing its Star Ratings Program for the Dialysis Facility Compare website.
Contrary to CMS’ announcement, a delay alone is not responsive to the concerns expressed by stakeholders and certainly not to those expressed by DPC. While CMS said it was “partnering with the ESRD community,” it has instead declined to consider input on how to design patient-friendly ratings, and ignored DPC’s requests to see consumer testing materials and the geographic distribution of star assignments.
In late August, DPC submitted comments to the Center for Medicare and Medicaid Services (CMS) on its payment-setting rule for dialysis facilities in 2015. The rule keeps next year’s payments for dialysis level with this year’s, following a mandate from Congress, but makes some changes to the ESRD Quality Incentive Program (“QIP”) that reduces payments to the lowest-performing facilities. Here are highlights of proposed changes along with DPC’s commentary:
Patient Satisfaction Survey Scores To Count Toward QIP Payment Reductions:
Can Dialysis Facilities Be Rated Like Movies and Restaurants?
DPC was saddened to learn of the recent passing of two of our previous board members, Robert (Bob) Mize and William (Bill) Litchfield. Robert Mize was one of three patients who served as a founding board member. He was instrumental in laying the groundwork for the successful advocacy and education programs we produce today. He frequently made trips to Washington, D.C. to elevate the patient voice and his dedication to promoting kidney disease awareness and education will surely be missed.
DPC is excited to announce the beginning of a new program to further engage kidney disease patients through education and advocacy. For the first time ever, DPC is hosting four regional meetings in sites around the country to bring dialysis patients together to engage on issues important to their care and well-being. The inaugural locations for these regional meetings are as follows: Detroit, Michigan; Seattle, Washington; Houston, Texas and New York, New York.
Last week, the Centers for Medicare and Medicaid Services (CMS) released its Proposed Rule specifying how dialysis facilities will be paid in 2015 and beyond. Most of the proposed changes relate to the Quality Improvement Program for dialysis. The Quality Improvement Program (QIP) sets performance standards for each clinic and penalizes clinics that do not meet or make progress toward the standards by cutting their payments by up to two percent. The purpose is to incentivize providers to do a better job by tying their pay to performance.
Congressmen John Lewis (D-GA) and Tom Marino (R-PA) have introduced the Chronic Kidney Disease Improvement in Research and Treatment Act in the U.S. House of Representatives. Lewis and Marino are leaders on the Congressional Kidney Caucus and have been staunch supporters of dialysis patients over the years. This bill seeks to advance several proactive kidney care policy initiatives and provides a vehicle for educating Members of Congress and the public about the issues facing kidney disease patients and the kidney community as a whole.
Meet Darrel Ratliff, who continues to run his shoe repair business while also being an in-center dialysis patient. Darrel was a diabetic for many years until lab tests in 2009 revealed values his doctor did not like. He was immediately admitted to the hospital and given two dialysis treatments that day. Results of a subsequent needle biopsy determined only four percent kidney function. Darrel has struggled with many health setbacks such as anemia, infection scares and allergies. He jokingly states that he must now follow a dialysis diet and that means, “if it tastes good, spit it out!”
The Center for Medicare & Medicaid Services (CMS) has an ongoing quality incentive program, the first of its kind, for End Stage Renal Disease (ESRD) care. The quality incentive program, or QIP, is intended to improve the care provided to ESRD patients by paying dialysis facilities based on the quality of care they deliver. If a facility fails to meet certain performance standards, they may receive a lower performance score which results in lower payments to the facility.