Twenty-six percent of medical director and renal administrators who responded to a Harris Interactive poll about the impact of the proposed bundled payment for dialysis said they believe their center may have to close its doors if changes aren’t made to the current proposal.

Beginning Jan. 1, 2011, a bundled prospective payment system for dialysis services will be required under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) enacted by Congress. There is currently a public comment period underway to solicit feedback from the community that ends on December 16, 2009 (for more information on how to file comments, go to www.regulation.com). After CMS has reviewed all of the submitted public comments, the agency will finalize the rules for the ESRD PPS.

The paper survey on the bundle was commissioned by Amgen Inc. and conducted by Harris from Oct. 9th to Nov. 16th. Participants worked at a dialysis center in the United States (renal administrators who worked at a national account/chain dialysis center and medical directors who worked at a hospital-based dialysis center and only provided acute care were excluded from the study). The study yielded 191 qualified respondents, with 81 medical directors and 110 renal administrators. Participants were recruited via telephone and qualified respondents were sent a paper survey via overnight mail or fax.

Other findings from the poll:

• Seventy-six percent of respondents believed the proposed rules would negatively affect patients’ quality of care. They indicated the percentage of patients with hemoglobin levels below 10 g/dL would almost double under the bundle (from 11% to 19%). Almost 7 in 10 respondents feel hospitalizations will increase as a result of the Proposed Rule. 


• Nearly nine in 10 respondents said oral medications without IV equivalents should stay out of the bundle; 70% of the respondents warned that inclusion will result in dialysis centers placing controls that will limit the use of oral medications. The majority of the respondents also believed that their dialysis center would be at greater financial risk by having to purchase and dispense oral medications without an IV equivalent.

• Sixty-seven percent in the survey suggest patients’ access to care would be compromised if the bundle as proposed is approved.


• Sixty-nine percent of respondents felt hospitalizations among dialysis patients are expected to increase as a result of the proposed rule.