For Medicare primary patients, cultures (blood and other) for dialysis access related bacteria are included in ESRD-related labs and are covered in the per treatment payment (not separately billable to Medicare) under the new prospective payment rate (bundle). Antibiotics to treat access-related infections are covered under the per treatment payment for dialysis. Access-related infections are supposed to be tracked on dialysis claims and each facility’s quality assessment and performance improvement (QAPI) team should review data on access-related infections looking for root causes, develop a plan to address those causes, implement the plan, check to see how well the plan is working and revise the plan as needed to address infections. There may be instances where a patient has a suspected staph or MRSA infection at another location that his/her primary doctor would need to address, but if the infection is access-related, dialysis facilities should not send patients to their primary physicians to have cultures drawn as a way to avoid responsibility for paying for the lab test(s) and antibiotics to treat them or taking responsibility for tracking and addressing access-related infections. If this is occurring, it should be reported to the State Survey Agency.
We’ve worked with the State Survey Agencies and the experiences have been good for the most part - renal networks on the other hand have been a different story, I hope the networks have improved over the years but haven’t seen evidence of that.