CMS projects 0.5% increase in total payments to end-stage renal disease facilities

November 15, 2017
Medicare Web

The acute kidney injury (AKI) dialysis payment rate is $232.37 for CY 2018, as updated by CMS in the 2018 End-Stage Renal Disease Prospective Payment System (ESRD PPS) final rule, which was released in late October. This payment rate would be equal to the ESRD PPS base rate after applying the 2018 wage index. 

CMS announced an update to the outlier services fixed-dollar loss (FDL) amount in the ESRD PPS based on 2016 rates. With this change comes a significant FDL decrease for pediatric beneficiaries from $68.49 to $47.79. Meanwhile, for adult beneficiaries, the FDL amount will decrease from $82.92 to $77.54. 

Additionally, pricing options for drugs and biologicals will be expanded beyond the average sales price methodology to include wholesale acquisition cost and average manufacturer price.

As a result of these policies and other adjustments, CMS projects a 0.5% increase in the total payments to all ESRD facilities for CY 2018. More specifically, 0.5% increase is expected at freestanding facilities, and a 0.7% increase for hospital-based ESRD facilities.