CMS Releases Bundled Payment and Value-Based Purchasing Rules


The Centers for Medicare and Medicaid Services (CMS) released a final rule on July 26 implementing a single Medicare bundled payment for a wide range of dialysis services. Effective January 1, 2011, Medicare will pay $229.63 per treatment (including dialysis-related treatment, supplies, drugs, and  lab tests), with adjustments based on a geographic wage index, case- mix variations, co-morbidities, new patients, pediatric patients, low volume, training programs for home/self-dialysis, and certain high-cost outliers. CMS also released a proposed rule on value-based purchasing (VBP) , beginning January 1, 2012, which would make further adjustments to dialysis payments based on clinical quality performance measures, including results of dialysis care management shown by lab tests, under a quality incentive program (QIP) authorized by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The rules affect nearly 330,000 Medicare patients with end-stage renal disease (ESRD) in 4,390 dialysis facilities receiving over $9.2 billion in Medicare payments annually. The QIP is part of a long term strategy to apply VBP more broadly to promote higher quality, better coordinated, more cost-effective care across a wide range of Medicare benefits. The new federal health care reform law requires CMS to implement VBP in Medicare payments for hospital services by October 1, 2012.

About Tom Entrikin

A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs. Since joining PCG in 1992, Tom has assisted in the design, development, and implementation of revenue projects for school-based health services; hospital-based and municipal projects for pregnant women, infants, and children; state services offered through youth services, child welfare, mental health, substance abuse, and public health agencies; and reimbursement systems for hospitals, long term care facilities, and community-based waiver programs. He has made presentations at national conferences on Medicaid waiver programs and participated in the development of a manual on self-determination under waiver programs for the Robert Wood Johnson Foundation.

Read More


Tags: , , , , , ,

Categories:Health and Human Services


blog comments powered by Disqus