CMS Needs to Get It Right! On July 1, 2013, Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for end stage renal disease (ESRD) reimbursement, set to take effect January 1, 2014. CMS’s proposed cuts based on drug utilization would be devastating to Medicare providers, reducing reimbursements by nearly 10 percent. In a period when healthcare is enduring some of the most dramatic changes of our lifetimes, when nephrology specifically has been adjusting to the care of older, sicker patients than ever before and a reimbursement system that has recently moved to a bundled structure, this cut is not only a slap in the face to all providers who have worked diligently to deal with scarce resources, but also risks negatively impacting Medicare beneficiaries. As the primary payer to the ESRD program, Medicare has a responsibility to get it right. The proposed cuts do not consider the reduction of $4/treatment already mandated due to sequestration. Furthermore, the amount of the latest proposed reduction was calculated by looking only at pharmaceutical utilization rather than at the provider’s total costs. If total costs were considered, and reductions were looked at more holistically at the dialysis unit level, no cuts would be proposed, as the current CMS reimbursement rate is already insufficient to cover providers’ costs for Medicare patients. The proposed cuts bring reimbursement significantly below the cost of providing the care. This will jeopardize the viability of some clinics, putting beneficiaries’ access to dialysis in their communities at grave risk. Dialysis providers, large and small, have been responsible in leading healthcare to improve quality of care. Year over year DaVita has made improvements in mortality, fistula rates and all other quality measures. CMS should embrace these improvements and reward rather than penalize the added value to beneficiaries. Each of us must engage our legislators with the reality of this ill-conceived cut. Additionally, we need to educate our patients about the extreme risk this proposed cut puts them under.
Posted on: Sun, 04 Aug 2013 00:02:28 +0000