ESRD Payment System Changes Proposed

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The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System.

If adopted, the changes would apply to dialysis services rendered from January 1, 2012, forward. Among other suggested revisions, CMS wants to eliminate the “50% rule,” and instead exclude all panel tests from the definition of ESRD outlier services and the outlier computation.

CME also wants to exclude certain thrombolytic agents when computing whether a facility is entitled to outlier payments, but include in the computation testosterone, anabolic steroids, and certain drugs used for anemia management.

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