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      Finances of the Independent Dialysis Facility

      Blood Purification

      S. Karger AG

      Medicare composite rate, Case mix adjustment, Payer mix, Bundled payment

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          Medicare pays 80% of the cost of dialysis treatment and associated medications. Congress directed the Centers for Medicare and Medicaid Services (CMS) to develop both a process of regular and more or less ‘automatic’ updates of composite rate setting and ‘bundling’ as much of the laboratory and ancillary medications as possible into the composite rate. In response to this mandate, CMS revised the wage indexing process, added an annual update, and removed the limits on the wage index range. CMS has moved the ‘margin’ from medication acquisition and administration to an annually revised ‘drug add-on’ to the composite rate and fixed reimbursement of separately billed medication (ancillary) to the average sales price +6%. CMS is funding a demonstration project on near 100% bundling to be completed by 2008 that will include metrics for automatically increasing the base composite rate.

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          Payment for Performance: In Sickness and in Health. For Better or for Worse?

          American consumers and payers are increasingly questioning the value of health care as costs increase amid reports of poor quality. Rewarding health care providers who apply evidence-based, clinical practice guidelines (CPGs) to obtain desired patient outcomes seems an intuitive, innovative method to improve health care value. Although there are many unanswered questions about payment for performance (P4P), Congress and the Centers for Medicare and Medicaid Services are developing a rapid timetable to begin P4P. Many private payers have already begun P4P programs. Currently, we lack randomized, controlled studies proving the safety, effectiveness, and patient centeredness of P4P. Many see publicly reporting provider performance as a surrogate for P4P. There is a growing literature documenting the effect of publicly reporting provider performance on the medical community and patient outcomes. It changes provider behavior, but occasionally, in undesirable ways (for example, adverse risk selection, or ‘cherry picking’). Publicly reporting or rewarding provider performance based on applying evidence-based CPGs may also have unforeseen negative patient outcomes. P4P should proceed carefully while considering unintended consequences for patients and providers. P4P should be pilot tested in the proper target patient and provider populations. Thus, we need to study how CPGs interact with one another in specific patient populations. The updating process for CPGs should include evidence-based statements concerning their impact on real patients with multiple chronic illnesses.

            Author and article information

            Blood Purif
            Blood Purification
            S. Karger AG
            December 2006
            14 December 2006
            : 25
            : 1
            : 7-11
            Medical Affairs and Quality Assurance, Centers for Dialysis Care, Cleveland, Ohio, USA
            96390 Blood Purif 2007;25:7–11
            © 2007 S. Karger AG, Basel

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            Figures: 1, Tables: 4, References: 10, Pages: 5
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