Financial planning

Key facts about PD reimbursement and ETC

The Centers for Medicare & Medicaid Services (CMS) continues to offer incentives for home therapy1

  • All dialysis modalities are reimbursed at the same prospective payment system (PPS) per-treatment payment rate, PD benefits under the bundle
  • The three-month waiting period for Medicare coverage is waived if patients choose home therapy over HD

How PD provides financial benefit to the healthcare system2

Average patient Average ICHD patient Average PD patient Net change ICHD vs.
PD patient
Number of reporting facilities NA 5,000 2,200 NA
Average revenue
per Medicare beneficiary year		 $41,000 $41,000 $42,000 $1.000
Average cost
per Medicare beneficiary year		 $41,000 $42,000 $37,000 ($5,000)
Average margin
per Medicare beneficiary year		 $200 ($800) $5,700 $6,500
% margin
per Medicare beneficiary year		 0.5% (2.0%) 13% 15%

Adapted from The Moran Company of Analysis 2014. Medicare Institutional Costs Reports submitted from over 4,750 chronic dialysis facilities.

FAQs

Why pre-dialysis education benefit is good for your patients while it reimburses you for your time3,4

Legislation established a Medicare benefit for pre-dialysis education regarding modality choices.3

What does this mean?
  • Medicare reimburses face-to-face, pre–end-stage renal disease education sessions.3,4
  • Patients in Stage 4 of chronic kidney disease (CKD) also qualify.3
What type of information should be covered in the pre-dialysis education sessions?3
  • Treatment options, including in-center hemodialysis, peritoneal dialysis, home hemodialysis, and transplant
  • Comprehensive information regarding options for renal replacement therapy
  • Management of comorbidities

The ETC model is already a reality

With Measurement Year 1 starting in January 2021, the ESRD Treatment Choices (ETC) model is well underway. ETC is a mandatory model that encourages greater use of home dialysis and kidney transplants by incentivizing dialysis facilities and clinicians to work with patients on the choice of treatment modality.  

How will the model impact your reimbursement?

Vantive’s ETC Calculator will help you understand how this payment model uses census data to calculate MPS points and ultimately reimbursement. The calculator provides useful information for scenario planning and only requires a few basic inputs. 

Click here to find out more
ETC Calculator screen
Click here to find out more

Do you know how ETC impacts your reimbursement?

There are two types of payment adjustments that arise from the ESRD Therapy Choices (ETC) Model

 

1

ETC
HDPA

Home Dialysis
Payment
Adjustment

RIGHT
NOW

+3%

 

Home Dialysis Payment Adjustment (HDPA) – positive adjustments applied for driving home therapy use1​. Dialysis Facilities and Managing Clinicians in the selected HRRs can earn the HDPA by caring for new and existing patients utilizing a home therapy HDPAs are currently adding 3% reimbursement for qualifying home patients

Chart showing home dialysis payment adjustment
 

2

ETC
PPA

Performance
Payment
Adjustment

CAN ADD

OR

SUBTRACT

 
+4% -5% 

PPA can ADD +4% or SUBTRACT -5% on 2022 reimbursement for ALL qualifying HOME & ICHD PATIENTS. The magnitude of the reimbursement impact will escalate throughout the course of the model to ADD +8% or SUBTRACT -10%

Performance Payment Adjustment (PPA) – Positive or negative reimbursement adjustments to the Facility Bundle PPS and Clinician MCP payments are applied to all qualifying traditional Medicare dialysis patients (ICHD, PD and HHD)1

Vantive’s ETC Calculator will show your current reimbursement trajectory and how it can be adjusted with scenario planning. 

Reimbursement impact can be viewed by payment period, or on an annualized basis with the PPA and HDPA portions split out.

PPA Measurement and payment schedule

THE CLOCK IS TICKING!

PPA Measurement Year 1 began in January 2021

Alarm clock illustration

For more information on ETC

Access the CMS ETC Webinar summary

Access the webinar

Need additional support on the ETC Model, PD therapy or PD products?

Call 1-800-284-4060 for your local Vantive representative who can provide resources that help you grow your PD program or for more information email [email protected]

References

  1. Rivara MB, Mehrota R. The changing landscape of home dialysis in the United States. Curr Opin Nephrol Hypertens. 2014;23(6):586-591.

  2. Baxter Internal Data on File. (2018). The Moran Company Summary of Analysis 2014.

  3. Medicare.gov. Your medicare coverage. Kidney disease education. Available at: https://www.medicare.gov/coverage/kidney-disease-edu.html. Accessed on August 1, 2018.

  4. Shukla AM, Easom A, Singh M, et al. Effects of a comprehensive predialysis education program on the home dialysis therapies: a retrospective cohort study. Perit Dial Int. 2017;37(5):542-547.