NN&I - July 2010
8 Nephrology News & Issues July 2010Subscribe to our free eNewsletter at www.nephronline.com Mr. Neumann has been editor of Nephrology News & Issues since 1989.FIRST WORDBy Mark E. Neumannwhich would have blocked the pay-ment cut until the end of 2011. On June 8, Senate Finance Committee Chairman Max Baucus, D-Mont., unveiled his version of the legislation, which includes the House-proposed 2.2% increase to Medicare physician payment rates for the remainder of 2010, and a 1% increase in 2011. But in January 2012, the SGR kicks back with an estimated 33% pay cut. Again, a temporary fix. For now, physicians might accept anything: Medicare contractors were poised to begin processing Medicare claims at the reduced rate. Makes you really want to be a Medicare patient, doesn't it? Congress, pay thy physiciansNo doubt, tough economic times have made us all grateful to be employed. Unless you work for a large corporation that participated in the government bailout and feel immune to handing out bonuses (thanks AIG), pay raises have been few and far in between. But the see-saw battle that Medicare physicians have been fac -ing over the last several years regard- ing their pay is beyond efforts by the largest health care payer in the coun-try to be thrifty. It's Congressional ineptitude. Last month, the Centers for Medicare & Medicaid Services asked its contractors to put claims for nephrologists and other physicians on hold for 17 days in the hopes that the House and Senate could come to an agreement on fixing the thorny sustainable growth rate, the formu-la that determines each year how much physician pay should be after weighing in the cost of the Medicare program. And each year, based on the SGR, physicians face a pay cut. Congress fumbles through a series of patches and temporary fixes to pass the buck, so to speak, until the next Medicare fee schedule arrives. This year, Congress passed three temporary delays, the last one extending the current physician pay rate through May 31, in an effort to try and reach an agreement. As NN&I went to press, a seven-month fix was on the table. The House had passed the American Jobs and Closing Tax Loopholes Act, or H.R. 4213, in May, Doing your homework on the bundle Waiting for the final version of the ESRD payment bundle, expected to arrive early next month, is like waiting for the home repair contractor to tell you how much it will cost to fix the damage to your house after that recent winter storm. It could be bad. Real bad. Or, you might get off easier than you think. The National Renal Administrators Association (NRAA) isn't waiting for the esti-mate. The national organization, which primarily represents small- to mid-sized U.S. dialysis providers, has developed a comprehensive estimating tool to help its mem-bers figure out if the payment bundle will be good news or bad news for their bottom line. The beta version of the tool was presented to NRAA members during two train-ing webinars last month. The good news is that the organization plans on publishing a final version of the estimating tool within two weeks after the details of the payment bundle are released--expected in early to mid-July. The estimating tool, developed in an Excel configuration, should be a mandate for clinics that are nervous about the bundle's impact. Developed by Washington, D.C.-based consulting firm Avalere Health, the spreadsheet gives dialysis clinic administrators two options: a "quick and dirty" review based on inputting limited information into the estimating formula, or a more comprehensive, detailed version where you can see drug usage (both IV and oral), clinical indicators like Kt/V, and case mix adjusters for each patient. Once that data is entered, the calculating tool determines how much Medicare would pay for those patients. Another useful fea-ture in the calculating tool is the ability to create your own case studies by changing various case mixes within your population to determine the impact on your bottom line. If, for example, you switch 10-15 of your patients from in-center hemodialysis to peritoneal dialysis, the worksheet will calculate the impact. The NRAA is smart enough to know that the impact of the bundle will be felt hardest by its core membership, the small dialysis providers who may not have a well-rounded mix in its patient population to help cover the risk of a bundled pay-ment. Many of the small independents have few resources to spare to handle extra paperwork, and the bundled payment formula will bring plenty. "Uninformed almost guarantees out of business in these days and times," one consultant noted. FirstWord_NNI0710_4.indd 8 6/16/10 4:14:52 PM
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