MedPAC and dialysis payment adequacy
by billp830, Sat Apr 28, 2007 at 05:44:03 PM EDT
Commenting on my previous post Matt points to MedPAC to dispute my contention that Medicare is not paying its way in the provision of diaysis.
The March 2007
MedPAC report (pdf) the summary is:
"In summary, most of our payment adequacy indicators are positive. Therefore, the recommendation is to update the composite rate" The final recommendation is to update the Composite Rate by 1.2%. Sounds like payments are about right but there's a catch.
The "payment adequacy indicators are positive." These indicators are that there was a measured increase in the number of treatments on pace with the growth in beneficiaries i.e. nationally supply kept pace with demand.
One might think that the MedPAC recommendations would be based on audited costs, but no they look at program growth as a surrogate. The thinking is if the program is growing then reimbursement must be adequate. What I was trying to explain is that it is the payments from private insurers that are driving program profits and as a result program growth.
States that base the Medicaid dialysis composite rate on audited costs pay a higher rate. The audited cost reports show that a single dialysis treatment costs more to deliver than Medicare pays, however, to get to the private payer honeypot, providers accept the partial payment from Medicare.
I do not think the MedPAC report and my post are at odds.
I do support the Bill, in general it is better than nothing and as Matt said there is no chance that the Bill will be passed and signed, rather another update will be tucked into some other CMS focused Bill. I like the other elements and would only want to strengthen some elements, things like tech certification. CKD education before starting dialysis is a obvious program improvement.
I wish I could do a better job explaining the larger point. The built in Medicare discount relies on over-charging private payers. If private payers were eliminated then public payers would have to pay more for the same services they currently buy at a discount. This is the case throughout the US health care system