Medicare Payment Policy

outpatient dialysis services
Chapter summary
Outpatient dialysis services are used to treat the majority of individuals with
end-stage renal disease (ESRD). In 2011, about 365,000 ESRD beneficiaries
on dialysis were covered under fee-for-service (FFS) Medicare and received
dialysis from about 5,600 dialysis facilities. For most facilities, 2011 is the
first year that Medicare paid them using a modernized prospective payment
system that includes, in the payment bundle, certain dialysis drugs and
ESRD-related clinical laboratory tests that facilities and clinical laboratories
previously received in separate payments. Medicare expenditures in 2011
for all outpatient dialysis services in the modernized payment bundle were
$10.1 billion. Controlling for changes in the items and services included in the
bundle, we estimate that payments increased about 1 percent between 2010
and 2011.
Assessment of payment adequacy
Our payment adequacy indicators for outpatient dialysis services are generally
positive.
Beneficiaries’ access to care—Measures include examining the capacity and
supply of providers, beneficiaries’ ability to obtain care, and changes in the
volume of services.
C H A p t e R 6
In this chapter
• Are Medicare payments
adequate in 2013?
• How should Medicare
payments change in 2014?
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