CHA News Article

CMS Estimates 0.8 Percent Payment Increase in 2014 for Hospital-Based ESRD PPS

Hospital-based dialysis facilities paid under the end-stage renal disease (ESRD) prospective payment system (PPS) will see an estimated 0.8 percent increase in payments for calendar year (CY) 2014 compared to CY 2013, according to a final rule issued by the Centers for Medicare & Medicaid Services (CMS). CMS estimates that independent ESRD facilities will see no increase in payments in CY 2014 as compared to CY 2013. The update reflects the effect of a 3.2 percent ESRD bundled market basket update; the Affordable Care Act-required productivity adjustment of 0.4 percent; the American Taxpayer Relief Act (ATRA)-required drug utilization adjustment of negative 3.3 percent; a 0.4 percent overall estimated increase in outlier payment from the updates to the fixed-dollar loss threshold and Medicare Allowable Payment amounts; and a 0.2 percent overall estimated increase in payments from the change in the blend of payments.

In response to comments, CMS will implement a multi-year transition for the ATRA-required drug utilization adjustment to mitigate the impact on providers by offsetting the reduction by the payment update to create an overall zero percent impact for all ESRD facilities from the previous year’s payments for CYs 2014 and 2015. For CY 2016, CMS will evaluate how to apply the balance of the reduction and determine if it should be applied in CY 2016 or if an additional transition year should be provided in CY 2017.

The final rule also includes provisions updating the ESRD quality incentive program (QIP) for payment year 2016. CMS finalized eight clinical measures and three reporting measures addressing infections, anemia management, dialysis adequacy, vascular access, mineral metabolism management, and patient experience of care. CMS will calculate performance scores by weighting clinical measures at 75 percent of the total performance score and weighting the reporting measures at 25 percent. The ESRD QIP will reduce payments to ESRD facilities that do not meet or exceed certain performance standards.

CMS has announced that a national provider call regarding the CY 2014 ESRD PPS final rule will be held on Jan. 15, 2014. CHA will notify members as more details about the call are available. The final rule is attached and is effective Jan. 1, 2014.