Medicare to bundle dialysis payments, reward facilities for training patients

The agency that oversees Medicare on Monday unveiled regulations that would bundle payments for dialysis treatments, supplies, drugs and laboratory tests. The new rules also encourage facilities to provide home dialysis training for end-stage renal disease (ESRD) patients, and for the first time reward facilities for meeting or exceeding quality measures in the Medicare fee-for-service system.

“The new payment system and quality incentive program for dialysis services have significant potential to improve patient outcomes and promote efficient delivery of health care services,” Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, said in a statement. “In addition, for the first time in any of our payment systems, the quality of care facilities furnish to patients will be reflected in their payment rates.”

The new regulations were mandated by the 2008 Medicare Improvements for Patients and Providers Act. The law was based on recommendations from the Government Accountability Office and the Medicare Payment Advisory Commission, which argue that Medicare overpays for dialysis drugs under the existing fee-for-service system — creating perverse incentives for dangerous over-prescribing.

“A bundled payment system for ESRD patients will lower costs, prevent over-prescription of dialysis drugs, and encourage efficient delivery of high quality care for ESRD patients,” said Ways and Means health subcommittee Chair Pete Stark (D-Calif.), a longtime advocate of bundled payments. “These regulations get us one step closer to that goal line.”

The bundled payments kick in Jan. 1.