News topics related to the dialysis industry
News topics related to the dialysis industry seem to range from focusing on therapy options, to changes in regulations, changes in submission of information and most recently reviewing the cost of End Stage Kidney Disease and its impact to insurance providers.
On June 21, 2022 the Supreme Court in Marietta Memorial Hospital Employee Health Benefit Plan vs Davita rejected the claims that the Ohio based hospital employee health plan discriminated against patients with end stage kidney disease by reimbursing at lower rates. 1 A study in JAMA Internal Medicine notes spending on outpatient therapy for ESKD patients is three times higher for insured patients than that of Medicare covered patients. Coordination of Benefits allows coverage for patients to extend for 30 months after eligibility for Medicare begins. 2
An increasing number of dialysis patients are turning toward the private insurance market with Medicare Advantage Plan flexibility and lower cost. These challenges have brought efforts on the part of large dialysis organizations to support along with Dialysis Patient Citizens (DPC) a new bill which will prohibit discrimination among dialysis patients and allow continued coverage under private insurance providers. Additionally, researchers expect to continue to see an increase in coverage by Medicare Advantage plans with legislative changes in 2021. 3
What does this mean for your dialysis facility?
First, monitor your patients. Assure they understand coverage eligibility. Review your current contracts. Make certain you have agreements in place covering both the primary and Medicare Advantage offerings of a payer.
Second, start thinking about your dialysis facility’s budget. As the budgeting season comes around, look at patient eligibility, coverage, and anticipated revenue. Are there things that will allow your facility to improve workflow, maximize communication and assure continuity of care? Be sure as you anticipate revenue, that you budget for solutions that will deliver quality, innovation, and service.
For more information, reach out to our team [email protected]
[1] U.S. Supreme Court rules against DaVita over dialysis coverage | Reuters
[1] Dialysis Costs the Healthcare System Three Times More in the Individual Market – USC Schaeffer
[1] Largest Medicare Advantage plans pay big markups for dialysis (medicalxpress.com)