Key facts about PD reimbursement and ETC
The ETC model is already a realityThe 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.
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?
Baxter’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.
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 | Home Dialysis | RIGHT | +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
2 | ETC | Performance | 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
Baxter’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.
THE CLOCK IS TICKING!
PPA Measurement Year 1 began in January 2021
Need additional support on the ETC Model, PD therapy or PD products?
Call 1-800-284-4060 for your local Baxter representative who can provide resources that help you grow your PD program or for more information email [email protected]