Creating Economic Stability in the Medicare Program

Creating Economic Stability in the Medicare Program

Medicare Reimbursement for Dialysis Remains at Risk: The average Medicare margins for dialysis facilities remains negative, despite the successful rollout of the ESRD Prospective Payment System (PPS) in 2011. There are a series of technical fixes that are necessary to ensure the PPS works as intended and would better align the payment rates with the cost of providing care. KCP will continue advocating for these corrections to be made to the PPS.

Protecting Access to Medicare Act of 2014 (PAMA): The Protecting Access to Medicare Act of 2014 (PAMA) (P.L. 113-93) provided the Medicare ESRD Program with some stability in implementing the large payment cuts required by the American Taxpayer Relief Act of 2012 (ATRA) (P.L. 112-240). However, PAMA did not eliminate the risk that the ATRA-mandated payment cuts pose for dialysis facilities. A recent analysis completed by The Moran Company shows that current payment rates coupled with sequestration and increasing costs, result in an estimated 50 percent of dialysis facilities below the break-even point in 2014. The planned payment reduction will result in payment rates in 41 states being negative by 2018.

An overwhelming majority of dialysis patients are Medicare beneficiaries, because in 1972, Congress committed to provide access to life-sustaining dialysis treatments for individuals through the Medicare program, regardless of age. Because of this unique program, dialysis facilities have no ability to alter payer mix. Further cuts Medicare ESRD payments could put patient access to care at greater risk.

Congress should maintain its commitment to the more than 430,000 Americans with kidney failure who are on dialysis and oppose additional payment cuts that could compromise access to this life-saving treatment.

Reference Documents

Learn More about The Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 4814) Introduced in the 113th Congress