Month: November 2017

Medicare Part D: Time to Review

Medicare offers prescription drug coverage to everyone with Medicare. If your patients decide not to get Medicare drug coverage when they are first eligible, they may be asked to pay a late enrollment penalty unless they have other creditable prescription drug coverage or are receiving Medicare’s Extra Help.

Every year, Medicare’s open enrollment period is October 15 – December 7. Medicare health and drug plans can make changes each year. These changes could affect the cost, coverage, and the providers and pharmacies in their networks. You can assist your patients by discussing their Medicare Part D coverage and timelines for the ESRD coordination of benefits period to ensure that they are prepared for the year to come.

To research Medicare drug plans use the Medicare Plan finder at: https://www.medicare.gov/find-a-plan/questions/home.aspx

ESRD PPS: Updates to Policies and Payment Rates

CMS issued a final rule that updates payment policies and rates under the ESRD Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2018. In addition, this rule finalizes updates to the acute kidney injury dialysis payment rate for renal dialysis services, as well as updates to the ESRD Quality Incentive Program for payment years 2019, 2020, and 2021. CMS projects that the updates for Calendar Year (CY) 2018 will increase the total payments to all ESRD facilities by 0.5 percent compared with CY 2017. For hospital-based ESRD facilities, CMS projects an increase in total payments of 0.7 percent, while for freestanding facilities, the projected increase in total payments is 0.5 percent.

The final rule also includes:

  • Update to the ESRD PPS base rate
  • Annual update to the wage index and wage index floor
  • Update to the outlier policy

See the full text of this excerpted CMS Fact Sheet (issued October 27).

Why Facility Data Reports Should Be Checked

CMS established the ESRD Quality Incentive Program (QIP) as part of its ongoing efforts to improve the quality of dialysis care provided to ESRD patients.

Annual Dialysis Facility Reports (DFRs) and Quarterly Dialysis Facility Compare (QDFC) Reports are made available to facilities, State Survey Agencies, and Regional Offices online at dialysisdata.org. Only authorized users can access the reports.

Facilities can use the DFR and QDFC reports to assist in their quality improvement efforts; state surveyors use the DFR data when deciding which facilities to survey. Facilities are given a chance to preview and comment on these reports. The quality measures from the reports are posted on the Dialysis Facility Compare website, which is used by patients to review and compare characteristics and quality information on approximately 6,500 dialysis facilities in the United States.

Dialysis facility staff are encouraged to review the facility’s data reports on a regular basis. For information on how to access these reports, visit the IPRO ESRD Network Program help portal.

Shortcut to Resources for National Healthcare Safety Network (NHSN)

Have you been to the National Healthcare Safety Network (NHSN) section of the Network web site? You’ll find a shortcut to your most frequently needed NHSN resources that include:

  • Required Training
  • Enrollment Steps
  • NHSH Event Protocol
  • NHSN Dialysis Event Surveillance Data
  • CMS ESRD QIP Rule Report
  • Health Care Personnel Safety Components
  • NHSN Contact Information

New Priorities and Goals Planned for ESRD Stakeholders

The Department of Health and Human Services (HHS) National Quality Strategy (NQS) is a national effort to align public- and private-sector stakeholders to achieve better health and healthcare for all Americans. It was developed “through a transparent and collaborative process with input from a range of stakeholders. More than 300 groups, organizations, and individuals, representing all sectors of the health care industry and the general public, provided comments.”

The Centers for Medicare & Medicaid Services (CMS) contracts with End Stage Renal Disease (ESRD) Networks to implement the NQS principles and HHS Secretary’s priorities in the ESRD community. Starting in December 2017, Networks will launch a set of new quality improvement activities, data reporting requirements, and educational programs that reflect updated priorities and goals.

HHS Secretary’s Priorities

  1. Reform, Strengthen, and Modernize the Nation’s Health Care System
  2. Protect the Health of Americans Where They Live, Learn, Work, and Play
  3. Strengthen the Economic and Social Well-Being of Americans Across the Lifespan
  4. Foster Sound, Sustained Advances in the Sciences
  5. Promote Effective and Efficient Management and Stewardship

CMS Goals

  1. Empower patients to make decisions about their health care
  2. Usher in a new era of state flexibility and local leadership
  3. Support innovative approaches to improve quality, accessibility, and affordability
  4. Improve the CMS customer experience

November is American Diabetes Month

According to the Centers for Disease Control and Prevention (CDC), more than 30 million children and adults in the United States are living with diabetes. At least 1 out of 3 people will develop diabetes in their lifetime. The American Diabetes Association has selected the month of November to raise awareness of the disease and its serious complications. The following resources can be helpful for dialysis staff and patients to discuss the importance of diabetes prevention and control: