CMS finalizes 2017 Medicare payment rates for dialysis facilities

At the agencies

On Oct. 25, CMS announced that providers and insurers will have an additional period to enroll for advance alternative payment models (APMs) for 2017. CMS will allow new applications for the Comprehensive Primary Care Plus Model and the Next Generation Accountable Care Organization Model. The APMs allow participating physicians the ability to earn an incentive payment under MACRA’s Quality Payment Program. An estimated 70,000 to 120,000 clinicians are expected to participate in the advanced APMs, with the estimate to grow in 2018 to 125,000.

In a blog post published on Oct. 17, Dr. Patrick Conway, the CMS’ Principal Deputy Administrator and Chief Medical Officer, announced CMS’ Comprehensive Primary Care (CPC) initiative’s second round of shared savings results. The results showed that 95 percent of practices met the quality of care requirements and four of seven regions shared the savings with CMS. During its second shared savings period in 2015, CPC generated a total of $57.7 million gross savings in Part A and Part B expenditures. Conway referred to the positive performance as evidence of CPC practices’ efforts to provide “comprehensive primary care.”

According to the CMS and private sector jointly sponsored Health Care Payment Learning & Action Network’s inaugural alternative payment model adoption survey report, an estimated 38 percent of healthcare dollars went through alternative payment models tied to healthcare quality in 2015. The survey showed most payments are still made through a fee-for-service basis, but a portion of healthcare plans and providers have shifted to the quality linked or population based models. Around 15 percent of healthcare dollars went through fee-for-devices structures measuring quality and value. Another 23 percent of dollars went through non-fee-for-service APMs, a value that could increase according to the report, in 2016.

On October 28, CMS published its final rates and rules for the 2017 Medicare payments for dialysis facilities treating end-stage renal disease patients. The final rule shows a slight average increase of 0.73 percent for facilities and a 0.9 percent increase for hospital-based dialysis facilities. In addition to the increase, the rule also changes the way Medicare pays for at home and self-dialysis training, altering the nurse training time used to calculate the payment rate to 2.66 hours, an increase from the 1.5 hours. The rule also places bid limits for at home dialysis medical equipment and finalizes that CMS will pay 2 percent less to end-stage renal disease treatment facilities that do not meet certain quality standards beginning in 2019. The rule takes effect Jan. 1, 2017.

In the courts

Following a recent Third Circuit Court ruling halting their proposed merger, PinnacleHealth System and Penn State Hershey Medical Center have announced they will stop their integration efforts. They cited “the time and cost associated with the continuing litigation” as reasoning for their decision. The U.S. Federal Trade Commission and the Commonwealth of Pennsylvania had sought to prevent the merger and had recently been successful in the Third Circuit, when the court ruled the government had shown the combination would likely be anti-competitive and would control 64 percent of the market of a half million residents.

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