Medicare: MedPAC Responds to ESRD Payments Rule, Urges Delay of New Dialysis Facility

August 20, 2014

Published by Bloomberg BNA
Michael D. Williamson
August 20, 2014

In comments to the CMS, a Congressional advisory commission addressed rebasing and revising bundling provisions found in the end-stage renal disease payments proposed rule for 2015, and it also urged the delay of a dialysis facility rating program not contained in the rule.

The Medicare Payment Advisory Commission (MedPAC), which advises Congress on the Medicare program, sent a letter Aug. 15 to the Centers for Medicare & Medicaid Services to address concerns about the end-state renal disease (ESRD) prospective payments proposed rule for 2015. The CMS published the proposed rule in the July 11 Federal Register (Fed. Reg. 40,208). Comments, which can be filed under docket number CMS-1614-P, are due Sept. 2 (128 HCDR, 7/3/14).

According to the proposed rule, payments to ESRD facilities would increase 0.3 percent in 2015, compared with 2014. Moreover, the proposal modifies the ESRD bundled marketbasket. MedPAC’s letter said the ESRD bundled marketbasket “forecasts how much providers’ costs would change in future years if the quality and mix of inputs they are to furnish care remained constant.”

In the proposal, the CMS said it would rebase the current ESRD bundled marketbasket to reflect input costs faced by providers in 2012 and revise the marketbasket by including more cost categories and changing some wage and price proxies that measure the rate of price change for each cost category.
The MedPAC letter also addressed the ESRD Five Star Rating Program announced by the CMS in a June 18 blog post, even though it’s not discussed in the ESRD proposed rule.

MedPAC Urges Rebasing Delay
MedPAC said it supports rebasing the ESRD bundled marketbasket, “using the most current and accurate data that are available because the market basket would better reflect the recent declines in dialysis drug use that occurred under the ESRD” prospective payment system (PPS).

However, the MedPAC letter urged the CMS to “use 2012 audited cost report data” to rebase the ESRD bundled marketbasket. According to the commission, the ESRD proposed rule included language that allowed for the use of unaudited reports.

To use the audited cost data, MedPAC said the CMS could delay rebasing the ESRD bundled marketbasket without changing 2015 dialysis spending. The commission said, “Delaying the implementation of the rebased ESRDB [ESRD bundled] market basket to 2016 in order to use audited cost data would not result in a change in 2015 total dialysis spending” because the Protecting Access to Medicare Act of 2014 (PAMA) sets the 2015 update to the ESRD PPS base rate at 0 percent.

Star Ratings Stir Concern
MedPAC also said the CMS should delay the implementation of the dialysis star rating system. The rating system, announced outside the proposal in June, will use various methods to determine a facility’s performance score.

According to the CMS blog post announcing the system, “Later this year and early in 2015, we’re adding a star rating system to the Hospital Compare, Dialysis Facility Compare, and Home Health Compare websites on The Compare sites are the official CMS source for information about the quality of health care providers, and the star rating system is just one of many ways we’re working to make quality information easier to understand and compare.”

To score ESRD facilities, “CMS will group measures into three domains, calculate the average of the values for the measure in each domain, and then calculate the final score by averaging the domain scored,” the MedPAC letter said.

The blog post announcing the system said it will begin in October.

The MedPAC letter said the varying methods and measures used to set a score “might result in a facility scoring high under one program and low under the other program.” MedPAC also said that “beneficiaries and their families might be confused if a facility’s star” rating and other, already existing, publicly available quality measures diverge.

In addition, the commission said the CMS should delay the program because it didn’t seek public comment on it. Their letter said the “CMS established the program through subregulatory guidance.”

Likewise, a letter sent to the CMS Aug. 20 by the American Kidney Fund, Dialysis Patient Citizens, the National Kidney Foundation and the Renal Support Network urged the CMS “not to rollout the ESRD Five Star Rating Program (ESRD Five Star) in October 2014 so that the Centers for Medicare and Medicaid Services (CMS) can work with the kidney care community and the patient organizations in particular to ensure that the program will provide useful and meaningful information to patients and their loved ones.”

See the original article here.