What is covered in the Bundle?

[Hartwell]

Section 1881(b)(14)(A)(i) of the Act, as added by section 153(b) of MIPPA, specifies that the ESRD PPS must represent a single payment to ESRD facilities for renal dialysis services in lieu of any other payment, and home dialysis supplies, equipment, and support services furnished pursuant to section 1881(b)(4) of the Act.
 
Section 1881(b)(14)(B) of the Act, which identifies the renal dialysis services that are to be included in the ESRD PPS payment bundle, provides the following:
the term renal dialysis services includes:

(i) items and services included in the composite rate for renal dialysis services as of December 31, 2010;

(ii) erythropoiesis stimulating agents and any oral form of such agents that are furnished to individuals for the treatment of end stage renal disease;

(iii) other drugs and biologicals that are furnished to individuals for the treatment of end stage renal disease and for which payment was(before application of this [new ESRD PPS]) made separately under this title, and any oral equivalent form of such drug or biological; and

(iv) diagnostic laboratory tests and other items and services not described in clause (i) that are furnished to individuals for the treatment of end stage renal disease.

[surroundedbybeauty]

Thank you, Lori and I'm sure others too, who have done so much to make the proposed Medicare changes understandable. I have read all that is on this chat room and watched the YouTube video, but I still don't understand the bottom line: What difference will it make? Will I notice anything different in how Medicare pays for dialysis now and how it would pay if the new guidelines were implemented. It would be helpful to have a before and after scenario to make this clear. Thanks.

[Hartwell]

A bundled dialysis payment system will take effect in 2011.  This payment system will include all drugs and services.  Medications administered during dialysis will no longer be billed separately.  Labs will be included is a bundled amount.  The dialysis providers will be provided a bundle payment and they along with the docs will decide what medications and labs the patients receive. 

In today's payment system it is mostly a fee for survive system.  if the doc orders meds it is billed separately, so their is no disincentive for the doc to order it.  Some people think that this has led to too much usage and not enough control on costs.     

The new payment system will change management and treatment parameters in dialysis and may have an impact on access to care, quality of life and may increase your co pays.  We as lo want to make sure that home dialysis is encouraged in the reimbursement model and that we have no problems traveling etc. 

We are still learning and hope to have a more concise list in the near future.

When ever reimbursement changes, so does practice and we always hope for the better. 

Kidney Care Council gives a good overview of the process. 
http://www.dialysispatients.org/images/pdf/Bundling_Final.pdf

[Flosschick]

Thanks for the information!  Does the new bundling system include safety measures/precautions that would encourage a physician to order extra labs (outside of the bundle) if indicated? 
Flosschick

[Danny Knight]

Under the new rule system will the Dialysis Clinics start to "Cherry Pick" the patients that they accept? If a patient is like me and has other medical problems will the center turn them down when they apply for treatment because they know that this new patient will cost them more for a treatment than someone that is only having kidney problems, or will there be a place for the Dr. to send a written letter to explain the circumstances and the clinic will be paid for other medical problems or will the patient be continuously turned down by clinics until the patient dies?

[Roberta Mikles]

This payment system will include all drugs and services.  Medications administered during dialysis will no longer be billed separately.  Labs will be included is a bundled amount.  The dialysis providers will be provided a bundle payment and they along with the docs will decide what medications and labs the patients receive 

This is becoming more of a concern to many who are contacting our group and many want to know that they will be able to obtain the medications and lab work necessary in order to have appropriate care. Many patients have lab work done more often due to their status and want to know if this will continue. What specifically does the bundle say is included e.g. what monthly labs, what bimonthly labs are covered? Will labs (more than monthly, or twice a month) be covered with 'medical justification'?

[Hartwell]

Flosschick,  I have been told that a medical justification can be filled out for extra labs, but  I am not sure.  Does anyone know how that will work?

It is stated that the doctor can order whatever he feels is medically needed and the dialysis facility has to pay for it.  The problem is a facility needs to make a profit in order to stay open.  So I am not sure how that will work.   
 

[hippoydave]

don't fix the funding at any specific level because every case is different. Some areas of medicine are treating people improperly because of financial considerations and failing the first directive re:do no harm.

I've already experienced  failure to treat  instances involving a broken ankle, a broken collar bone, and three vertebrae  where the Dr.s obviously wouldn't treat properly because they didn't want to rationalize the costs.
the lower back  damage precipitated the broken ankle because of lack of sensation.
the  collar bone has effected my breathing.
And the broken ankle has made standing very difficult.
In these cases, the billing reflects several office visits but no surgical endeavors.