Most Providers to See Reimbursement Drops From the Bundle

Large dialysis organization (LDOs) are expected to see the biggest drop in reimbursement in 2011 due to the new bundled payment system, according to an analysis by the Centers for Medicare & Medicaid Services.

On Table 35 on the final rule for the End-Stage Renal Disease Prospective Payment System (PPS), CMS tabulated the expected effects the bundle will have in 2011 on various types of dialysis facilities.

Click HERE to access the bundle rule. Table 35 is on p. 165 of the pdf.

In the final impact table, LDOs are projected to experience a 3 percent decrease in payment under the PPS compared to what they would have received in the absence of the PPS.

Medium-sized dialysis organizations (which are captured under the heading regional chains) are projected to experience a 0.9 percent decrease, and small dialysis organizations (SDOs) are projected to experience a 0.3 percent decrease. Hospital-based facilities are the only provider expected to see an increase, which is 1.7 percent.

Those predictions are based on CMS’s assumption that 43 percent of dialysis facilities would choose to be excluded from the bundle transition, and that 57 percent of clinics would choose to be paid the blended rate under the transition.

In addition, urban clinics are expected to see a 2.1 percent decrease in reimbursement in 2011, and rural clinics are projected to see a 1.6 percent drop.

Across the United States, facilities in the south Atlantic region are expected to see a 4.1 percent decrease in reimbursement in 2011, and clinics in the Mountain region are expected to see a 3.1 percent increase in reimbursement.