Per Treatment Payments

I just got back from DC and believe we have a very important issue that needs immediate advocacy. As you know bundles payments are coming soon, but it hasn’t been completely decided what they will look like. One very significant thing to be decided is how reimbursements will be paid. CMS is considering three methods: per treatment, weekly or monthly. Currently many of the MAC’s are paying for as many treatments a dialyzor does if the neph signed the proper paperwork to show medical justification, typically fluid overload or congestive heart failure. This may be more difficult in the future is weekly or monthly reimbursements is chosen. We need to be prepared to act very soon to make sure a pre treatment reimbursement is selected.

I, for one, will be writing my federal legislators with this important message.

Have you heard which MACs routinely pay for four or more treatments with medical justification and what the maximum number of treatments they pay for is? I know that some people don’t want to draw too much attention to the practice of paying for 4 or more treatments for fear those that do pay will be convinced to stop. According to the CMS website, there are 15 different MAC jurisdictions. In some cases payers won the contract for more than one jurisdiction:

Federal legislators voted for bundling to save Medicare money. I don’t know whether they’ll be convinced to reverse that decision. They may only have considered the cost savings and not the unintended consequences that patients worry about.

Bundling is supposed be effective in 2011 and it’s supposed to have a 3-year phase in period. I believe they’re still working on the plan and when the proposed plan is ready, it will be published for public comment. It will say where to send comments. CMS staff must read and record every comment received during the comment period. They must also take all comments into consideration in the final regulation. You’ll see comments on various topics in the preamble to a regulation (the part before the actually regulation text) with the CMS response to those comments. From what I’ve observed, convincing comments with data/references can influence the final text of the regulation.

Hi Folks

Any idea as to the bottom line ? I would have a hard time thinking that the people looking out for the companies. Would they take less ? In this time in our country what I thinking is Dr’s /whatever Tx centers,(dialysis, heart issues etc) CMS is going to be told to push results. Get the person to stop smoking, drinking, eating better. For dialysis it maybe a how many people the unit can get to at least try a home therapy. Plus infection control. I saw two of the hearing and infection was in the top ten problems . Can you answer if a person is on a home therapy I think the unit get payed the same as if I was in center? True or False

Bob O’Brien

I want some type of reward for taken on the job of doing dialysis at home.Maybe a yr end cash payment or a drug discount on the big cost meds. The center if I do a go job and the center help (really helps) help make the change over from a non dialysis to a person on dialysis a lot smoother?

Maybe some of you have read this but , just in case…