09.06.13
On July 1, the Centers for Medicare and Medicaid Services (CMS) released a Proposed Rule for the Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for 2014, which also proposes changes to the ESRD Quality Incentive Program (QIP) for payment year 2016 that provides payment incentives to dialysis facilities to improve the quality of dialysis care. Under the ESRD QIP, facilities that do not achieve a minimum total performance score—a method by which CMS evaluates quality of care—with respect to quality measures established in regulation receive a reduction in their payment rates under the ESRD PPS. This rule also addresses issues related to the coverage and payment of durable medical equipment, prosthetics, orthotics, and supplies.
Lawrence, Mass.-based NxStage Medical Inc. has a hefty stake in the changes in the reimbursement structure for end-stage renal disease proposed by Medicare/Medicaid. The company makes the NxStage System One, a portable hemodialysis system for home use. NxStage submitted public comments to CMS, calling the agency to correct the current insufficient and inequitable payments for home hemodialysis (HHD) training, making the modality more accessible to Medicare patients suffering from ESRD.
According to NxStage, the requested changes were based on:
“Today’s add-on payment of $33.44 per training session (intended to represent 1 hour of nursing time) is simply too low and does not adequately represent the time and effort required to ensure safe, quality care at home,” said Joe Turk, president, NxStage. “Given the clear and compelling benefits of home hemodialysis and the decades-old congressional intent to encourage home dialysis and rehabilitation, it is essential that CMS update its policies for training payment to ensure beneficiary access to this modality. It is a disservice to patients to allow this situation to remain unresolved.”
NxStage focuses on technology for the treatment of ESRD and acute kidney failure.
Lawrence, Mass.-based NxStage Medical Inc. has a hefty stake in the changes in the reimbursement structure for end-stage renal disease proposed by Medicare/Medicaid. The company makes the NxStage System One, a portable hemodialysis system for home use. NxStage submitted public comments to CMS, calling the agency to correct the current insufficient and inequitable payments for home hemodialysis (HHD) training, making the modality more accessible to Medicare patients suffering from ESRD.
According to NxStage, the requested changes were based on:
- Clinical data supporting superior patient outcomes with HHD, including more frequent HHD, vs. conventional in-center dialysis;
- Third-party surveys showing that nephrologists and other healthcare professionals would choose HHD most often for themselves if faced with ESRD, contrasting sharply with the small percentage of beneficiaries with access to HHD today;
- A congressional mandate for CMS to develop policy that encourages more patients to be rehabilitated and treated in the home setting; and,
- Reliable analysis of CMS cost data showing that actual costs incurred per HHD training session ($251-261) are substantially in excess of the current add-on payment ($33.44 per session) for the required training services.
“Today’s add-on payment of $33.44 per training session (intended to represent 1 hour of nursing time) is simply too low and does not adequately represent the time and effort required to ensure safe, quality care at home,” said Joe Turk, president, NxStage. “Given the clear and compelling benefits of home hemodialysis and the decades-old congressional intent to encourage home dialysis and rehabilitation, it is essential that CMS update its policies for training payment to ensure beneficiary access to this modality. It is a disservice to patients to allow this situation to remain unresolved.”
NxStage focuses on technology for the treatment of ESRD and acute kidney failure.