Modality Selection

Under the current Centers for Medicare and Medicaid (CMS) reimbursement regulations, choosing the appropriate modality for the patient and the facility is very important. CMS has shown if the modality is right for the patient, Peritoneal Dialysis is the cheaper modality and CMS will reimburse more for this modality. Let’s take a look at how CMS reimburses for the two modalities:

Peritoneal Dialysis

Hemodialysis (In-Center)

Payment for the monthly management of PD patients is the same as 2 to 3 face to face visits even though no visit is required.

Up to 15 days of training are re-imbursed.

With reduction in drug reimbursement, peritoneal dialysis patients are less costly to facility due to lower drug usage.

Doctors are required to furnish 2 to 3 face to face visits a month, in order to receive same level of payment as peritoneal dialysis.

There is no re-imbursement to facility for the 1st (3) months of dialysis services.

With reduction in drug reimbursement, Hemodialysis patients are more costly to facility due to higher drug usage.

As you can see, the appropriate modality selection can greatly influence the profit line of a facility.