ASN End-Stage Renal Disease Task Force

Abstract

For the first time in nearly 30 years, the Centers for Medicare and Medicaid Services (CMS) will implement a new payment system for dialysis patients. Since 1983, Medicare has reimbursed each dialysis session with a prospective payment—known as the composite rate—designed to cover the cost of center or home dialysis.1 Since implementation of the composite rate, however, new therapies—including erythropoietin, vitamin D, and iron—have emerged as new additional costs for standard dialysis care. These therapies are reimbursed separately from the composite rate and now compose approximately 40% of the total Medicare payment for each dialysis treatment.2 To improve the efficiency and flexibility of the ESRD Program, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 mandated implementation of a comprehensive, case mix–adjusted, bundled-rate payment system for ESRD that includes therapies currently reimbursed outside the composite rate.3 The ESRD Prospective Payment System will be phased in on January 1, 2011, and fully implemented by 2014. Although MIPPA outlines the basic approach to bundling, the legislation grants CMS authority to finalize the components of the bundle and generate a detailed implementation plan. In September 2009, CMS released for public comment a proposed rule on ESRD bundling and is expected to issue a final rule on ESRD bundling in 2010. In addition, CMS is projected to release a proposed rule on a quality improvement program for ESRD care. Given the monumental significance of the new payment system, the American Society of Nephrology (ASN) formed an ESRD task force to assess and respond comprehensively to the proposed rule changes. Eight ASN members from diverse specialties and practice settings served on this task force, including early-career and established nephrologists as well as ASN policy staff. ASN's foremost concerns relate to preservation of patient access to optimal dialysis care and related …