Bundled Payment Options: Data Tables

ESRD Bundled Payment Options

Index of Data Tables

Table

Page

Table Key

Bundle Defintions

Drugs

Laboratory Tests

Table 0-1 ¡ª Summary of Options: All Patients

Table 0-2 ¡ª Summary of Options: PD Patients

Table 0-3 ¡ª Summary of Options: HD Patients

Table 0-4 ¡ª Summary of Options: HD Patients / ¡®Full Month¡¯

Table 0-5 ¡ª HD Equivalent Sessions

Table 0-6 ¡ª Composite Rate Services

Table 1A-1 ¡ª Bundle 1A Total MAC

Table 1A-2 ¡ª EPO and Aranesp

Table 1A-3 ¡ª Iron

Table 1A-4 ¡ª Vitamin D

Table 1A-5 ¡ª Anemia Lab Tests

Table 1A-6 ¡ª Vitamin D Lab Tests

Table 1B-1 ¡ª Bundle 1B Total MAC

Table 1B-2 ¡ª Levocarnitine

Table 1B-3 ¡ª Altaplase

Table 1B-4 ¡ª Vancomycin

Table 1B-5 ¡ª Infection Lab Tests

Table 1B-6 ¡ª Carnitine Lab Tests

Table 1C-1 ¡ª Bundle 1C Total MAC

Table 1C-2 ¡ª Other injectable drugs

Table 1C-3 ¡ª Other Lab Tests

Table 1D-1 ¡ª Bundle 1D Total MAC

Table 1D-2 ¡ª Other facility services

Table 2A-1 ¡ª Bundle 2A Total MAC

Table 2A-2 ¡ª Physician MCP

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

April 1, 2005

Definition of bundle components and column headings

Description

Statistic / Components

All patients

Obs

Mean

Std Dev

C.V.

Percentile

5th

25th

50th

75th

95th

IQR

Percent of:

PM

Pts

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

Per month

Per month

HD-equivalent sessions

Number of HD sessions (for HD patients) or number of PD days multiplied by 3/7 (for PD patients)

Composite rate services

Payment under the composite rate system

Bundle 1A Total

EPO and Aranesp

Vitamin D

Iron

Anemia Labs

Vitamin D Labs

Composite rate payment plus sum of components listed in following rows

Bundle 1B Total

Levocarnitine

Alteplase

Vancomycin

Infection Labs

Carnitine Labs

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

See definitions for Bundle 1A at end of tables.

See definitions for Bundle 1B at end of tables.

Bundle 1C Total

Other Injectables

Other Labs

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 1D Total

Other Facility Services

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 2A Total

Physician MCP

Bundle 1D payment (including composite rate) plus MCP payment

Physician Medicare Capitation Payment

Table Key

Page 1 of 143

Key to reading tables

April 1, 2005

Definition of bundle components and column headings

Description

Obs

Mean

Std Dev

C.V.

Percentile

5th

25th

50th

75th

95th

IQR

Percent of:

PM

Pts

Statistic / Components

All patients

Per session

Per session

Indicates whether statistics in following rows are

expressed on a per month or per session basis

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

% 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

Mean value of dependent variable

Number of observations (patient months)

Table Key

Page 2 of 143

Preliminary - March 11, 2005

Bundled Drugs and Laboratory Tests

Drug

HCPCS / Revenue Center (RC)2 Codes

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

Category

Bundle 1A:1

EPO

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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