ESRD Policy

Medicare and end-stage renal disease have been tightly connected ever since 1973, when Medicare began to cover dialysis treatment, regardless of age. Today, over 80% of all patients undergoing maintenance dialysis have Medicare coverage, under either the fee-for-service arrangement in Medicare Parts A and B or the newer capitated arrangement in Medicare Advantage. Of course, even that line has blurred in recent years, as risk-sharing arrangements such as Comprehensive ESRD Care and Kidney Care Choices have attracted profound interest.

The bottom line is that dialysis care is heavily influenced by Medicare policy, and that policy is guided by the data that the federal government collects, both in healthcare claims and in the ESRD Quality Reporting System. CDRG has in-depth knowledge of Medicare policy pertaining to dialysis care and the relationship between policy and data. CDRG can provide detailed analytics and studies about numerous Medicare policies on reimbursement and quality, including:

• ESRD Prospective Payment System, including outlier services
• Transitional Drug Add-on Payment Adjustment (TDAPA)
• Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES), including the extension to home dialysis equipment
• ESRD Quality Incentive Program (QIP)
• Dialysis Facility Compare (DFC) Star Ratings
• Dialysis Facility Reports
• ESRD Treatment Choices (ETC), a new payment model that incentivizes increased use of home dialysis, which launched in 2021
• Kidney Care Choices (KCC), a risk-sharing arrangement for nephrology practices, transplant programs, and allied dialysis providers that launches in 2022

CDRG has extensive experience with federal data and understands the intricacies of dialysis facility claims. CDRG also understands the complex specifications of quality measures in the ESRD QIP, including attribution of patients to dialysis facilities and risk adjustment schema.

Whether your company needs to forecast the consequences of proposed Medicare policy, increase attention to the limitations of existing policy, or set a strategy for success in ETC and KCC, CDRG can provide objective analysis of data that can be used for purposes ranging from quality improvement to political advocacy.

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