Bundled Payment Options: Data Tables

ESRD Bundled Payment Options Index of Data Tables

Table

Table Key Bundle Defintions

Drugs Laboratory Tests Table 0-1 -- Summary of Options: All Patients Table 0-2 -- Summary of Options: PD Patients Table 0-3 -- Summary of Options: HD Patients Table 0-4 -- Summary of Options: HD Patients / `Full Month' Table 0-5 -- HD Equivalent Sessions Table 0-6 -- Composite Rate Services Table 1A-1 -- Bundle 1A Total MAC Table 1A-2 -- EPO and Aranesp Table 1A-3 -- Iron Table 1A-4 -- Vitamin D Table 1A-5 -- Anemia Lab Tests Table 1A-6 -- Vitamin D Lab Tests Table 1B-1 -- Bundle 1B Total MAC Table 1B-2 -- Levocarnitine Table 1B-3 -- Altaplase Table 1B-4 -- Vancomycin Table 1B-5 -- Infection Lab Tests Table 1B-6 -- Carnitine Lab Tests Table 1C-1 -- Bundle 1C Total MAC Table 1C-2 -- Other injectable drugs Table 1C-3 -- Other Lab Tests Table 1D-1 -- Bundle 1D Total MAC Table 1D-2 -- Other facility services Table 2A-1 -- Bundle 2A Total MAC Table 2A-2 -- Physician MCP

Page

1 3 3 4 13 15 17 19 21 24 30 36 42 48 54 60 66 72 78 84 90 96 102 108 114 120 126 132 138

Note to user: Each of the tables beginning with Table 0-6 (for compositerate services) consists of six pages. These pages display a consistent set of measures, as follows:

The first page displays statistics on payments per month for patients categorized patients by modality, sex, age, diabetes status, body surface area, and duration of renal replacement therapy.

The second page displays statistics on payments per session for these same categories of patients.

The third page displays statistics on payments per month for patients categorized patients by type of month and facility characteristics.

The fourth page displays statistics on payments per session for these same categories of patients.

The fifth page displays statistics on payments per month by renal network.

The sixth page displays statistics on payments per session by renal networks.

ESRD Bundled Payment Options Index of Data Tables

The following map may be helpful to those not familiary with the states covered by the renal networks.

Key to reading tables Definition of bundle components and column headings

April 1, 2005

Description Statistic / Components All patients

Percentile

Obs Mean Std Dev C.V.

5th

25th

50th

75th

The dependent variable, e.g., sessions, composite rate payments, component payments

Per month

Per month

95th

Percent of: IQR PM Pts

HD-equivalent sessions

Composite rate services

Bundle 1A Total EPO and Aranesp Vitamin D Iron Anemia Labs Vitamin D Labs

Bundle 1B Total Levocarnitine Alteplase Vancomycin Infection Labs Carnitine Labs

Bundle 1C Total Other Injectables Other Labs

Bundle 1D Total Other Facility Services

Bundle 2A Total Physician MCP

Number of HD sessions (for HD patients) or number of PD days multiplied by 3/7 (for PD patients) Payment under the composite rate system Composite rate payment plus sum of components listed in following rows

See definitions for Bundle 1A at end of tables.

Bundle 1A payment (including composite rate) plus sum of components listed in following rows

See definitions for Bundle 1B at end of tables.

Bundle 1B payment (including composite rate) plus sum of components listed in following rows Hepatitis B vaccine, flu vaccine, cefazolin, ceftriaxone, cefazidime, heparin sodium and filgrastim. All other labs billed by the top 10 freestanding providers of laboratory services and not already bundled. Bundle 1C payment (including composite rate) plus sum of other facility services All other services billed by dialysis facilities not included in bundles 1A, 1B, or 1C Bundle 1D payment (including composite rate) plus MCP payment Physician Medicare Capitation Payment

Table Key Page 1 of 143

Key to reading tables Definition of bundle components and column headings

April 1, 2005

Description Statistic / Components All patients

HD-equivalent sessions

Percentile

Percent of:

Obs Mean Std Dev C.V.

5th

25th

50th

75th

95th IQR PM Pts

Per session

Per session

Indicates whether statistics in following rows are expressed on a per month or per session basis

Composite rate services

Bundle 1A Total EPO and Aranesp Vitamin D Iron Anemia Labs Vitamin D Labs

Bundle 1B Total Levocarnitine Alteplase Vancomycin Infection Labs Carnitine Labs

Bundle 1C Total Other Injectables Other Labs

% of patients with claims > 0 during year % of patient months with claims > 0

Interquartile range (75th/25th percentile) Percentiles of dependent variable

Coefficient of variation (SD / Mean) Standard deviation of dependent variable

Bundle 1D Total Other Facility Services

Mean value of dependent variable

Bundle 2A Total Physician MCP

Number of observations (patient months)

Table Key Page 2 of 143

Bundled Drugs and Laboratory Tests

Preliminary - March 11, 2005

Category

Drug

HCPCS / Revenue Center (RC)2 Codes

Bundle 1A:1 EPO

Epogen Darbepoetin alfa

RC 0634 or 0635, HCPCS Q9920 - Q9940 J0880

Iron

Iron dextran

Iron sucrose

Sodium ferric gluconate

Unclassified

J1750, J17603 J1756, J17553 J2916, J29153 J34904, W02335, X01075

Vitamin D

Calcitrol Doxercalciferol

Paricalcitol Calcitonin salmon (indication-specific)

J0636, J06353 J1270 J2501, J25003, W02375 J0630

Bundle 1B Levocarnitine Alteplase, recombinant Vancomycin

J1955 J2997 J3370

Notes

All bundles: specification of a bundle in terms of specific codes could lead to substitution with other service codes that are not in the bundle.

Bundle 1B 1 These three types of injectables accounted for 97.1 percent of Medicare payments to dialysis facilities for injectables during 2003.

2 These are the codes used to identify reimbursement for these injectables based on 2003 Medicare outpatient dialysis facility claims. They are HCPCS codes unless otherwise identified as revenue center codes (this applies to EPO only). Different codes could be used in other years.

3 Although these HCPCS codes were deleted prior to 2003, they continued to appear on paid dialysis facility claims for 2003, in some cases because a grace period extended their use for part of the year.

4 This code is for unclassified drugs, but has been used to bill for iron as codes for new iron products were being developed. This code accounts for less than 0.2 percent of iron payments to dialysis facilities during 2003. 5 These are local codes that were defined by certain fiscal intermediaries. These local codes account for 0.1 percent of iron payments and 0.1 percent of vitamin D payments to dialysis facilities during 2003.

Bundle 1B 1 This example (1B) adds to example 1A the only three injectables that were designated for reimbursement based on average acquisition payment amounts that were not included in example 1A, as well as laboratory tests that may be related to the use of these three injectables.

2 Specification by brand names has the potential for clinical substitution of other more profitable/separately billable injectables. Specifying injectables by clinical indication might be a more effective strategy.

3 Together with EPO, iron and vitamin D, the above three injectables accounted for 98.4 percent of Medicare payments to dialysis facilities for injectables during 2003.

Source: KECC

Bundle Definitions Page 3 of 143

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