ESRD Bundle Payment System and the ESRD Quality Initiative

ESRD Bundle Payment System and The ESRD Quality Initiative

Introduction

The “Centers for Medicare and Medicaid Services” (CMS) is originally intended to the “Health Care Finance Administration” (HCFA). It was designed under the Department of Health and Human Services by means of Reorganization Order of March 9th, 1977 (www.federalregister.gov). Currently, the CMS is serving 100 million people in the field of Medicare, Medicaid, and the “State Children's Health Insurance Program” (SCHIP), the “Health Insurance Portability and Accountability Act” (HIPAA), and several other health-related programs. CMS is managing and ensuring the health care concerns of all the people of United States of America (www.cms.gov).

In 2010, the CMS finalized the ESRD payment system to be based on the “Prospective Payment System” (PPS). ESRD is End Stage Renal Disease, which is medicated under the payment system of PPS. The new system of PPS is referred as the Bundle system. This system is mainly associated to the payments related to the services rendered in the dialysis units. The CMS pays one single payment for availing these services related to dialysis. It includes hemo-dialysis and many other services which are really expensive. Therefore, the management of the dialysis units is getting effective financial impacts with this method of bundle payment. The physicians and the employees are serving diligently in this age of dialysis Bundle (www.cms.gov).

Discussion

ESRD stands for End Stage Renal Disease. It occurs when the kidneys of a person fail to work properly, and result in a life time chronic condition for the person. The person cannot live without a dialysis or kidney transplant. These ESRD cases are caused as a result of diabetes or high blood pressure problems. The other causes include the problems since birth, the reactions of some medicines or some specific injuries can also cause ESRD (www.kidneyfund.org).

The CMS is serving the ESRD patients in terms of bundle payment method of PPS (Prospective Payment System). This new payment system has changed the business practices in terms of reimbursement of dialysis and management strategies in the field of dialysis units.

Hemo-Dialysis

When a person's kidneys are not working well enough to take care of the body's needs, he needs the treatment of Dialysis for improving the kidney's performance. It is required necessarily at the time of end stage kidney failure in terms of losing the 85-90 percent functioning of the kidney. Dialysis improves the level of certain chemicals like potassium, sodium, and bicarbonate in the blood. It also helps the controlling of blood pressure (www.kidney.org).

These failures can get better after treatment, but certain problems are not treated fully by these dialysis. Such chronic conditions require the approach to dialysis for the whole life, which is Hemo-dialysis. In Hemo-dialysis, the patient's kidney is replace by an artificial kidney for removing the waste and other extra fluids or chemicals form the blood. The kidney used is referred as the “Hemodialyzer”, with which the dialysis specialists are required to access the blood vessels of the body. This is done by minor surgeries ...