Re­cal­cu­lat­ing dial­y­sis pay­ments

Bun­dled dial­y­sis pay­ments tar­geted in lat­est deal

Modern Healthcare - - FRONT PAGE - Beth Kutscher

Less than one month af­ter the Government Accountability Of­fice called on the CMS to re­cal­cu­late pay­ments to dial­y­sis providers, the fis­cal cliff com­pro­mise sets in mo­tion cuts that would squeeze out $4.9 bil­lion in sav­ings.

The Dec. 7 GAO report ar­gued that Medi­care has been over­pay­ing for end-stage re­nal disease treat­ment by re­ly­ing on 5-year-old drug use trends that are no longer ac­cu­rate.

Yet the cuts run even deeper than the GAO’s cal­cu­la­tions, which es­ti­mated that the CMS could have saved be­tween $650 mil­lion and $880 mil­lion in 2011 if the pay­ments were more in line with cur­rent pre­scrib­ing trends.

The de­bate over bun­dled pay­ments dove­tails with an on­go­ing con­tro­versy about the safety of a key group of drugs known as ery­thro­poi­etin-stim­u­lat­ing agents. The block­buster prod­ucts—in­clud­ing Am­gen’s Epogen and Aranesp well as John­son & John­son’s Pr­o­crit—rep­re­sent Medi­care’s sin­gle-largest drug ex­pen­di­ture.

ESAs treat ane­mia that of­ten re­sults from kid­ney disease. But af­ter they were linked to blood clots, stroke and heart at­tacks, the Food and Drug Ad­min­is­tra­tion in June 2011 changed its pre­scrib­ing guide­lines to

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