ESRD reform still on table with Grassley legislation

The ESRD Bundle and Annual Update

Grassley’s bill calls for a 1 percent increase in the composite rate paid to dialysis centers in 2009 and 2010, which would lead up to the implementation of a bundled payment system for dialysis in 2011.

The ESRD bundle in Grassley’s legislation does not include vaccines, and would provide payment on services given during a week or month. The Grassley bundle includes the following services.

• Items and services included in the composite rate as of Dec. 31, 2010
• Erythropoiesis-stimulating agents
• Other drugs and biologicals that were previously billed separately
• Diagnostic laboratory tests

As with Baucus’ bill, Grassley’s legislation also has provisions that would adjust the bundled payment to dialysis providers. That includes a case-mix payment adjustment that takes into account a patient’s weight, body mass index, comorbidities, time on dialysis, age and other factors.

In addition, Grassley’s bundled payment would adjust payment based on high-cost outliers that have variations in the amount of care needed, including ESAs for anemia management. Rural and low-volume facilities would also receive a payment adjustment in the proposed bundle. 

An annual update would begin in 2012, under the Grassley bill. It would be based on “changes over time in the prices of an appropriate mix of goods and services included in renal dialysis services minus 1 percentage point.”