FOCUS ON FINANCE: New Conditions for Coverage vs. Your Bottom Line

Process- vs. Outcome-Centered

CMS first proposed to overhaul the CfCs in February 2005 and published a “proposed rule” that was meant to modernize the CfCs and reflect technological changes in dialysis delivery.

Key to the goals set for the new CfCs was a shift in emphasis from ensuring sound structure and adequate delivery processes towards focusing on patient outcomes, patient involvement, and ongoing optimization of patient care via an interdisciplinary team-based approach. The new CfCs “charge each facility with carrying out a program of its own design to continually improve quality outcomes and patient satisfaction.”

Patients are given the option to be proactive in their treatment and should “know their healthcare options in advance.” The CfCs emphasize that “Patients need access to information regarding the quality of doctors, hospitals, dialysis facilities and other providers in their area, as well as the costs of various medical procedures.”

By increasing transparency, and facilitating patient access to quality of care metrics, the concept is that the interdisciplinary care team will increasingly focus on, and improve, patient outcomes.

The new CfCs are a collaborative effort, incorporating many recent medical, scientific and practice guidelines and standards of practice such as NKF’s Kidney Disease Outcomes Quality initiative (NKF - K/DOQI).

Reduced Administrative Burden

The new CfCs are also meant to remove unnecessary administrative policies and reduce the administrative burdens faced by providers. Although some requirements have been streamlined, others have been added. So whether providers realize any net reduction in administrative work remains to be seen. In future articles of this mini series on the CfCs, we will be looking at the obvious and hidden costs/benefits of the new CfCs in some detail and inviting your comment on how to maximize any savings and minimize the cost of implementation while maintaining quality care.