CMS recently issued a proposed rule detailing updates and revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014 and requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2016 and beyond.   CMS estimates that the proposed revisions to the ESRD PPS will result in a decrease of approximately $970 million in payments to ESRD facilities in CY 2014.   Among the provisions of the Proposed Rule, CMS is proposing an update to the ESRD PPS base rate for CY 2014.  For CY 2014, CMS proposes an ESRD PPS base rate of $216.95.  In addition, CMS proposed updates to the outlier services fixed dollar loss amounts for adult and pediatric patients and Medicare Allowable Payments (MAPs) for adult patients for CY 2014 using 2012 claims data, which CMS believes will increase payments for ESRD beneficiaries requiring higher resource utilization in accordance with a 1 percent outlier percentage.

CMS established in previous rulemakings the ESRD QIP for PYs 2012 through 2015.  In this Proposed Rule, CMS details a total of 14 quality measures for the PY 2016 ESRD QIP and future payment years, including measures to evaluate anemia management, dialysis adequacy, patient safety, and patient experience.  CMS did not propose measures that address care coordination, efficiency, population and community health, or cost of care, but is soliciting comments on potential measures for those areas.  Based on the Proposed Rule, CMS expects hospital-based ESRD facilities will have an estimated 9.3 percent decrease in payments compared with freestanding facilities with an estimated 9.4 percent decrease.  Comments to the Proposed Rule must be received by 5 p.m. E.S.T on August 30, 2013.  A copy of the Proposed Rule, which is published in today’s Federal Register, may be read here. 

Reporter, Christina A. Gonzalez, Houston, +1 713 276 7340, cagonzalez@kslaw.com.