Baucus unveils legislation with significant ESRD reform

The payments, according to the bill, would be made for services given in a week or month. In addition, the system would include a case-mix payment adjustment that takes into account a patient’s weight, body mass index, comorbidities, time on dialysis, age, race, and ethnicity, among others factors.

The proposed bundled payment would also have a payment adjustment for “high-cost outliers” that have large variations in care, including the amount of ESAs needed to treat anemia. A payment adjustment will also be included for low-volume dialysis clinics that have higher costs than other clinics. The bill also calls for adjustments to be made for pediatric care, geographic wage differences and rural dialysis centers.

The Baucus bill also calls for an annual increase in payment starting in 2012. Payments will increase based on a system that “reflects changes over time in the prices of an appropriate mix of goods and services included in renal dialysis services minus 1.0 percentage points.”

Clinic Performance Scores

The proposed legislation also looks to increase the accountability of dialysis providers by tying together payment and quality, in addition to publicizing performance.

Under the Baucus bill, providers face a 2 percent reduction in payment if certain quality parameters aren’t met. These quality measures include: anemia management and patient satisfaction, as well as iron management, bone mineral metabolism and vascular access. A “performance score” would be used to figure out whether a clinic will face a reduction in payment. The scores would be made public, according to the bill, so clinics can be compared to a national average.

To increase accountability, the bill would require dialysis clinics to display, in clear view, a certificate with the performance score it received. In addition, CMS will have to create a Web site that lists the performance scores for each clinic.