The Dialysis Bundle and Patients


An important change is being made to the way dialysis care is provided in the United States. This development is occurring outside of the high-profile discussions about comprehensive healthcare reform, but how dialysis patients’ care is funded is no less important than the policies being debated in the halls of Congress.

The change is underway with the Centers for Medicare & Medicaid Services’ (CMS) recent release of their proposed new bundled payment structure, also referred to as “the bundle.” Unveiled on Sept. 15, the new payment system was passed into law as part of the Medicare Improvements for Patients and Providers Act (MIPPA) in July 2008. MIPPA specified that reimbursement for dialysis services and medications—including dialysis labs, Epogen and many dialysis drugs—will be paid to dialysis providers in one lump payment. The bundle will be phased in over three years beginning in January 2011.

From the perspective of Dialysis Patient Citizens (DPC)—the nation’s largest patient-led dialysis organization, representing 23,000 dialysis and pre-dialysis patients and their families—it is of utmost importance that the new payment structure continue to allow patients choice and flexibility in receiving their treatments and ensure optimal clinical outcomes.

Within the proposed rule, CMS kept a few key elements on dialysis reimbursement intact. Most notably, CMS decided to reimburse dialysis providers per-treatment as opposed to per month or per week. This affords patients flexibility in where they receive their dialysis. For example, when a patient takes a vacation and receives dialysis at another clinic, it will be easier for that clinic to be reimbursed for each treatment the patient receives with a per-treatment reimbursement. CMS also continued to allow for patients to receive more frequent dialysis with medical justification. This preserves an important payment structure, as more studies are showing that patients have better outcomes with more frequent dialysis. However, there are also a number of areas in the proposed rule that need to be considered in order to ensure that quality of patient care does not decline.

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