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Renal Business Today managing editor Kasia Michalik is a graduate of Walter Cronkite School of Journalism. She joined Virgo Publishing in March 2012.

How the Fiscal Cliff Affects Dialysis


The fiscal cliff was avoided, for now at least, when President Barack Obama signed the Fiscal Cliff Bill on Thursday, January 3.

Hopefully, the bill will stave off another recession, but how will it affect healthcare and dialysis?

"The bill delays the budget cuts scheduled to occur on January 2 through budget sequestration for two months, repeals the Affordable Care Act's CLASS Act, extends the Medicare 'Doc Fix' for one year, extends unemployment insurance for one year and provides for a one year extension of the farm bill," the Prime Policy Group said in a letter to the National Renal Administrators Association (NRAA).

Changes to the Medicare End-Stage Renal Disease (ESRD) Program will also be enforced that will affect the renal industry.

The Sustainable Growth Rate (SGR) got a one-year fix and the physicians will avoid the predicted 27 percent payment cut in Medicare.

To rebase the ESRD prospective payment system (PPS) the Secretary of the United States Department of Health and Human Services (HHS) will use drug utilization data from 2012. The Congressional Budget Office (CBO) predicts a saving of $4.9 billion over 10 years. Average Sales Prices (ASP) as well as change in prices for drugs and biologics will be taken into account.

In 2016, the oral drugs in the PPS will go into effect, delaying the original inclusion by two years. By Jan. 1 2016, the Secretary is to review case-mix adjustments and make changes in payment based upon review.

By Dec. 31, 2015, the Government Accountability Office (GAO) is directed to produce a report about how the Secretary has addressed points raised in an earlier report about the Secretary's preparations to implement payment for oral drugs in the bundle.

A two-month delay to a possible $11 billion Medicare payment cut has been put into effect allowing Congress to figure out a way in which to avoid those.

Last, but not least, the issue of fraud in the transport of dialysis patients was addressed by reducing reimbursements for ambulance providers rather than by requiring or allowing clinics to provide transportation.

The PrimePolicy Group said it feels that the cuts could have been a lot worse but it is very troubling that the ESRD program was part of a small group of providers who took cuts to pay for the SGR fix extension.

The NRAAsaid it will be in communication with the Centers for Medicare & Medicaid regarding the rebasing the PPS and will keep members informed on any further developments.

Let us know what your feelings are about the cliff, the cuts, or any other issue facing the ESRD community.


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