Table 1.
Major policy changes in ESRD and palliative care in the past 15 years
| Policy | Year of introduction | Description |
|---|---|---|
| Tiered fee-for-service physician reimbursement for dialysis services (“G-codes”) | 2004 | Changed physician reimbursement for outpatient dialysis services from capitated payment to tiered fee-for-service payments. |
| ESRD Prospective Payment System (PPS; “the bundle”) | 2010 | A patient-level and facility-level adjusted per treatment (dialysis) payment for renal dialysis services that includes drugs, laboratory services, supplies and capital-related costs related to furnishing maintenance dialysis. |
| ESRD Quality Incentive Program (QIP) | 2010 | A value-based purchasing program in which payments to ESRD facilities are reduced for facilities that do not meet certain performance standards. |
| Pre-ESRD Education in the Medicare Improvements for Patients and Providers Act (MIPPA) | 2010 | Entitles Medicare beneficiaries with stage 4 CKD to receive six educational sessions about management of comorbid conditions, preventing complications, and kidney replacement therapy options. |
| Medicare Access and CHIP Reauthorization Act (MACRA) | 2015 | A Medicare value-based purchasing program that financially incentivizes healthcare providers to provide high-quality, cost-efficient care. |
| Comprehensive ESRD Care Model | 2015 | Dialysis clinics, nephrologists and other providers join together in ESCOs to coordinate care for beneficiaries with ESRD receiving dialysis. Providers are eligible for shared savings payments based on Medicare Part A and Part B costs and may be liable for shared losses. |
| Medicare Care Choices Model | 2015 | Allows Medicare beneficiaries to receive hospice-like support services while concurrently receiving curative care. Participation is limited to beneficiaries with advanced cancers, COPD, CHF, and AIDS. |
| Hospice Wage Index and Payment Rate Update | 2015 | Re-affirmed eligibility of dialysis patients with non-ESRD terminal diagnoses to receive both dialysis services and hospice |
| Advance Care Planning Reimbursement | 2016 | Voluntary advance care planning services may be billed by physicians and non-physician practitioners as a separate Medicare Part B service or an optional element of Annual Wellness Visit |
| CHRONIC Care Act (proposed) | 2017 | Expands telemedicine coverage under Medicare Advantage Plans, including telemedicine in home dialysis facilities and home-based primary care services for people with multiple chronic conditions. |
| Palliative Care and Hospice Education and Training Act | pending | Establishes palliative care workforce training, supports national palliative care education and awareness campaign, and enhances research in palliative care. |
Abbreviations: CHIP – Children’s Health Insurance Program; ESRD, end-stage renal disease program; ESCO, ESRD Seamless Care Organization; COPD, chronic obstructive pulmonary disease; CHF, congestive heart failure