WASHINGTON - A new report from the HHS Office of the Inspector General has found that the average per treatment utilization of certain drugs used to combat anemia in dialysis patients was 22 percent less than the quantity assumed in Medicare rates. This report reinforces the appropriateness of an American Taxpayer Relief Act provision that directs the Secretary to adjust bundled End Stage Renal Disease (ESRD) payments to reflect a change in utilization of ESRD drugs. Ways and Means Committee Ranking Member Sander Levin (D-MI) and Health Subcommittee Ranking Member Jim McDermott (D-WA) today released the following statements on the report. BACKGROUND BELOW
“This new analysis reflects that the dialysis bundled payment system is affecting efficiencies within the program," said Rep. Levin. “As CMS moves forward with payment changes to reflect this drop in utilization, I expect them to do so ensuring that beneficiaries continue to have access to a quality program."
“It is critical that the Medicare program pay dialysis providers adequately to ensure quality care and access,"said Rep. McDermott. “Still, Medicare must be a smart shopper and not overpay for services, particularly as we find better ways to cut waste. Today’s report confirms that we can absolutely find savings in Medicare without compromising quality."
Background
The OIG report found the average per treatment utilization of certain drugs used to combat anemia in dialysis patients was 22 percent less than the quantity assumed in Medicare rates. This report reinforces the appropriateness of an American Taxpayer Relief Act provision that directs the Secretary to adjust bundled End Stage Renal Disease (ESRD) payments to reflect a change in utilization of ESRD drugs.
The OIG estimates that Medicare and beneficiaries would have saved $529 million in 2011 if the ESRD base rate had been adjusted to reflect a drop in anemia management drugs. OIG’s preliminary analysis also indicates that utilization of anemia management drugs in the bundled payment continued to decline during the first eight months of 2012.
The OIG findings are consistent with a similar study conducted by the Government Accountability Office, which was released in December 2012. It found that utilization of ESRD drugs in the bundle for 2011 was about 23 percent lower, on average, than it was in 2007, which was the base year used to set levels for pre-ATRA bundled payment policy.
