Medicare Drops IRT Payment Changes With Health Equity In Mind

The Centers for Medicare and Medicaid Services on Friday unveiled a final rule for end-stage kidney disease payments next year this includes a small increase for stand-alone and inpatient dialysis.

The rule also aims to promote home dialysis services and transplant care for people from underserved communities, marking the agency’s first effort to address health disparities for Medicare registrants. suffering from kidney failure in the decade since Congress established the potential payment system for IRT providers. CMS released the proposed rule for ESRD payments in July.

“Today’s final rule is a decisive step in ensuring that medicare people with chronic kidney disease have easy access to quality care and convenient treatment options,” said said CMS administrator Chiquita Brooks-LaSure. “Enabling dialysis providers to offer more dialysis treatment options to Medicare patients will catalyze better health outcomes, greater independence and a better quality of life for all patients with kidney disease. “

The disparities between patients with end-stage renal disease are well documented. Hospital readmission rates are 19% higher for black patients with ESRD than for whites, according to CMS. People of color also face higher costs for kidney care. Outpatient bills for American Indians, Asians, Blacks and Hispanics for IRT are 5-12% higher than those for white patients. People in these populations are also less likely to have dialysis at home and to be put on waiting lists for a kidney transplant.

Under the final rule, CMS will award providers higher scores if they increase dialysis and home transplant rates for dual Medicare-Medicaid registrants and for low-income beneficiaries. These statuses are often used as indicators of socioeconomic status and race.

Also as part of the ESRD Treatment Choices model, which is part of what was finalized on Friday, the agency will stratify providers who serve a higher proportion of dual-qualifying patients or who are low-income grant recipients in order to not to disproportionately penalize these providers. .
The final rule also includes salary increases for hospital providers of 3.3% and for independent establishments an increase of 2.5%. All told, the increases represent an estimated overall increase of 2.5% from 2021, the agency said. The agency said it was working to resolve technical issues created by the pandemic and in the quality reporting system in general. As a result, no facility will benefit from a payment reduction for 2022.
In addition, the regulation will allow providers to offer free kidney disease education services through telehealth after the pandemic public health emergency is over. The agency cited access to transportation as a major barrier to these services which were mitigated following the COVID-19 temporary waiver that allowed the delivery of telehealth.

In addition, some beneficiaries, even those with reliable transportation, may be more comfortable receiving education services for patients with renal failure via telehealth rather than attending in person. after more than a year of social distancing, even when it becomes safe under federal guidelines for those recipients to enter physical spaces with other people, ”the agency said in the final rule.

As part of the 2022 prospective payment system for IRT, Medicare has estimated that it will pay approximately $ 8.8 billion to approximately 7,700 facilities for dialysis services, and comes with an increase of 4.77 $ from the current base rate of $ 253.13.
The agency will also postpone reports on several quality measures that it believes would negatively impact providers due to the pandemic, including the clinical measurement of the standardized hospitalization ratio and the clinical measurement of the catheter rate to long term.
Going forward, CMS asked for comments on stratifying quality measures by race, disability status, LGBTQ + status, and other factors. He also asks for feedback on how to move ESRD quality measurement into the digital space.

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