NN&I - June 2010

National 10 Nephrology News & Issues June 2010Subscribe to our free eNewsletter at www.nephronline.comA new report by the Government Accountability Office on the ESRD bun-dled payment system recommends that the Centers for Medicare & Medicaid Services monitor access to and quality of care for certain beneficiary groups as soon as possible after implementation of the new system. Rep. Pete Stark, D-Calif, chair of the House Ways and Means Health Subcommittee, and Rep. John Lewis, D-Ga., chair of the House Ways and Means Oversight Subcommittee, re-quested the report to assess whether there are unique factors that would affect continued access to care under the new payment system, particularly for vulnerable populations. GAO analyzed 2007 data on Med- icare end-stage renal disease expend- itures and input from 73 nephrology clinicians and researchers. The GAO also reviewed reports and CMS's pro- posed rule on the payment systems design and interviewed CMS officials. According to the report, popula-tions of dialysis patients have vary- ing costs. Black, dually-eligible, and younger ESRD patients have higher- than-average costs, and Asians and elderly patients have lower-than-aver -age costs. The GAO recommended that CMS monitor access to and quality of care for certain beneficiary groups as soon as possible after implementation of the new system. In response to the report, CMS announced its intention to have a comprehensive system in place to monitor the quality of care once the bundled payment system is implemented. GAO reviews potential impact of ESRD bundle Compiled by Mark E. NeumannDialysis groups, senators concerned about proposed VA payment cuts for ESRDThe Kidney Care Partners, The Kidney Care Council, Dialysis Patient Citizens (DPC), and the chairman of the Senate Veterans Affairs Committee issued mostly critical com -ments to the Department of Veterans Affairs last month for its proposal to use Medicare rates to cover outpatient dialysis services. The agency says it can save 39% in payments to non-VA managed dialysis clinics for patient services, and 75% in lab test payments by switching to Medicare pricing.DPC Executive Director Chad Lennox wrote that they "are concerned the current proposal will actually harm veterans' access to care," and result in some patients "hav-ing to spend more money out of pocket or utilize other federal and state dollars to continue receiving life-saving dialysis treatments." American Renal Associates co-founder and chairman Christopher Ford (representing The Kidney Care Council), and DaVita Inc. CEO Kent Thiry (representing Kidney Care Partners) wrote, "The economics of dialysis facilities are extremely fragile and most facilities treat many patients at a loss. A reduction in the reimbursement rate for veterans could destabilize the current economic balance and cre -ate access to care problems. Veterans would be forced to change dialysis providers and perhaps travel greater dis -tances to get to dialysis." Sen. Daniel A. Akaka, D-Hawaii, chairman of the Senate Veterans Affairs Committee and Sen. Mark Begich, D-Alaska, wrote that they are concerned that the VA is trying to over -simplify the complicated Medicare payment system, which is about to be overhauled. They also raised concern about the VAs ability to provide accurate payments under a com-plex system. A VA Office of Inspector General report from August 2009 found that 37% of claims from the VA Fee Basis Program for different services were improperly paid and that the VA has improperly reimbursed dialysis providers in the Fee Basis Program under the simpler current rule requiring payment under the 75 percentile methodology, the senators said. The VA must reimburse providers for these underpayments, because this causes serious concerns regarding how the VA would accurately pay providers under the evolving and more complex Medicare payment methodology, they said. CMS clarifies vascular access infection modifiersThe Centers for Medicare & Medicaid Services is trying to clarify with renal providers the type of information it needs to record vascular access infections among dialysis patients.The agency says it has been getting numerous ques-tions on the new modifiers to be used on dialysis-related claims starting July 1, particularly dealing with the V8 and V9 modifiers for access infections. Access infections are one of three new modifiers that clinics will need to report on; the others are adequacy and access type. Both V8 and V9 are line item codes; if a patient has a confirmed access infection then V8 would be coded [ NATIONAL, continued on page 13 ] National_NNI0610_9.indd 10 5/17/10 2:26:28 PM