Design for a Bundled End Stage Renal Disease Prospective Payment System. Report to Congress

摘要

Based on CY 2006 Medicare claims data there are currently about 4,700 facilities furnishing outpatient maintenance dialysis to an estimated 315,000 Medicare dialysis patients. In 2006, total Medicare expenditures for dialysis and dialysis related drugs totaled $8.1 billion. Currently, payment for outpatient maintenance dialysis services furnished to patients with end-stage renal disease (ESRD) is made on a per treatment basis known as the composite payment rate. The composite rate is a partially bundled prospective rate covering services furnished by ESRD facilities. However, ESRD facilities bill separately for certain dialysis-related services such as ESRD-related drugs and laboratory services that are outside the composite rate and payment is made under fee-for-service rules. In 2005, the composite payment rate system accounted for approximately $4.8 billion or 60 percent of the $7.9 billion in Medicare spending for outpatient dialysis services, while the remaining 40 percent represents payment for separately billable items. The average Medicare payment per dialysis treatment in 2005 was $237.02, of which $143.20 was for composite rate services and $93.82 was for separately billable services. The Government Accountability Office (GAO) and the Medicare Payment Advisory Commission (MedPAC) have endorsed expanding the current partially bundled payment system to include separately billable services under a fully bundled ESRD PPS.