Dialysis bundling and small dialysis organizations: A call for close monitoring

摘要

More than 400,000 people undergo treatment with maintenance dialysis in the United States. Although patients with end-stage kidney disease, both those treated with dialysis and those with a functioning kidney transplant, constitute only 1.3% of the Medicare population, they account for 7.5% of total Medicare spending. In an attempt to control costs, the US Centers for Medicare & Medicaid Services instituted the prospective payment system (PPS) for dialysis, known as the "bundle," on January 1, 2011. The policy's intention is to control dialysis costs by adding services that previously were billable separately, such as additional laboratory tests and medications, to the composite dialysis payment rate. Initially, only injectable medications, such as erythro-poiesis-stimulating agents (ESAs), intravenous iron, and vitamin D, were included in the bundle; the plan is to add oral dialysis-related medications (phosphate binders, oral iron and vitamin D formulations, and calcimimetics) in 2014. The introduction of the PPS was closely followed by the Quality Incentive Program (QIP), which began on January 1, 2012. The QIP, which is based on clinical data collected from dialysis units, penalizes 0%-2% of dialysis facility income for failure to meet anemia and dialysis adequacy targets. This is the first Medicare program that ties provider payments to performance.