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CMS Proposes Slight Increase in ESRD Payments for CY 2015

July 14, 2014—The Centers for Medicare and Medicaid Services (CMS) July 2 posted on its website a proposed rule that contains changes to the calendar year (CY) 2015 end stage renal disease (ESRD) prospective payment system (PPS) and the ESRD quality incentive program (QIP).

CMS will implement final changes to the ESRD payment system Jan. 1, 2015, and proposed requirements for the ESRD QIP would affect the 2017 payment year. Additionally, the proposed rule contains changes related to durable medical equipment. Comments on the proposed rule are due Sept. 2, 2014.

Under the proposed rule, payments to all ESRD facilities would increase slightly, by 0.3 percent.  Hospital-based facilities would receive a 0.5 percent increase, compared to freestanding facilities, which are estimated to receive a 0.3 percent increase. Although the market basket increase together with the multifactor productivity update would have resulted in a 1.6 percent increase, the Protecting Access to Medicare Act of 2014 (PAMA) requires a 0.00 percent update. 

Under CMS’ proposed rule, the base payment per dialysis session would be $239.33.

CMS also proposes to implement the new Core Based Statistical Area (CBSA) delineations based on 2010 Census Data with a two-year transition period. In CY 2015, CMS proposes to base 50 percent of payments on the CY 2014 CBSA delineations and 50 percent on the proposed CY 2015 CBSA delineations; in CY 2016, payments would be based entirely on the CY 2015 CBSA delineations.

Additionally, because of declines in drug utilization and the share of the payment related to drug costs, CMS proposes to change the labor-related share significantly from 41.737 to 50.673 percent of payments, also with a two year transition. For CY 2015, CMS proposes to base 50 percent of payments on the old labor-related share and 50 percent on the new labor-related share, for a proposed labor-related share of 46.205 percent. For CY 2016, CMS proposes to base 100 percent of payments on the new labor-related share, for a proposed labor-related share of 50.673 percent.

For the ESRD Quality Incentive Program (QIP), CMS proposes a total of 11 measures for payment year (PY) 2017. Ten of these measures will be continued from the CY 2016 QIP. The one measure proposed for removal is percentage of Medicare patients with a mean hemoglobin value greater than 12 g/dL, which CMS has determined to be topped-out. CMS proposes one new clinical measure: Standardized Readmission Ratio, which assesses the rate of unplanned readmissions of ESRD patients to an acute care hospital within 30 days of an index discharge from an acute care hospital. For the PY 2018 QIP, CMS proposes to transition the patient experience measure (ICH CAHPS) from pay-for-reporting to pay-for-performance, and to add five new measures to the Program.

The full list of measures can be found in the proposed rule.


Scott Wetzel, M.P.P.
Lead, Quality Reporting
Telephone: 202-828-0495


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