Leanne Zumwalt, VP of investor relations with DaVita, Inc., a major provider, says industry leaders’ disagreement doesn’t rest with the necessity of the budget neutrality factor, but with CMS’ calculation. The “2 percent haircut” was expected but the projection that calls for a 3.1 percent reduction in payments is off, she says.

In the final rule, CMS stated that it’s considering making an adjustment if its projection is over or underestimated, but not until 2012.

“More facilities are going to opt-in than CMS anticipated and that will unfortunately remove a lot of money from the system that can be used during this transition period,” says DPC’s Lennox.

Facilities are required to decide if they are going to opt-in or transition over four years to the new PPS by Nov. 1. Providers are urging CMS to wait until all of the facilities make their decisions to then recalculate its transition adjustor.

“We believe that CMS should be using real data and they will have real data starting Nov. 1,” says Satellite’s Chow.

In addition to the anticipated payment reduction, providers who choose to take the four-year route to the new PPS will also face some administrative challenges.

“The claims are a nightmare. For the phase-in period, when you have the potential for the blended rate, what they’re going to require from facilities in terms of claims data is extremely onerous,” says UH Case Medical Center’s Wish. “They’re not only going to have to include the claims data from the old system, which includes all the separate billables, but they’ll also have to include all the claims data for the new system, which are all the case-mix adjustors. It’s basically twice as much data, collection and reporting.”

A win for home dialysis
Perionetal home dialysis accounts for about 8 percent of the U.S. patient population, but some industry experts hope to see that percentage grow. Advocates of home dialysis were satisfied with CMS’ decision to create a home or self-care dialysis training payment adjustment for facilities certified to provide home dialysis training.

Originally, CMS limited payments for home training to the first 120 days of care with an add-on for providers. Advocates responded that this mechanism discourages providers from training patients beyond that time period, prompting CMS to adopt a separate adjustment for both hemodialysis and peritoneal dialysis modalities.

“The reimbursement rate for home dialysis training has been increased so that it’s more economically feasible for dialysis providers to do that training. The final rule allows facilities that do provide only home dialysis training to be calculated as a small provider. That means they can get an additional level of reimbursement,” says National Kidney Foundation’s Chianchiano. “All in all, I think everyone assumes with good reason that there will be an increase in the number of patients who are on home dialysis. We believe that more patients are suited for home dialysis than are currently receiving their treatments at home.”

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