THE BUREAU OF NATIONAL AFFAIRS: MEDICARE REPORT - JULY 5, 2002
Renal Disease Network Criteria Change Will Encourage Accountability, CMS Says
New criteria that the Centers for Medicare & Medicaid Services developed for evaluated end-stage renal disease networks were published in the June 28 Federal Register (67 Fed. Reg. 43613).
The criteria are used to evaluate the performance of the ESRD network organizations under the Medicare program to ensure effective administration of program benefits. The notice said this is the first time CMS has changed the criteria since 1987.
CMS's notice said its goals included "transitioning to a more patient-centered focus" and "shifting from a procedural approach to a more outcome-oriented approach."
The current standards call for review of individual cases for error, according to the notice. Instead, the new procedures will emphasize accountability of the entire network to CMS and internal review within the network of individual errors.
Nonprofit Networks. ESRD networks are nonprofit, nongovernmental organizations that were established in 1978 by amendments to the Social Security Act to administer dialysis or kidney transplantation for patients suffering from the chronic illness.
The transformation of the system began with the implementation of the Health Care Quality Improvement Program in 1994, which sought to bring "typical care into line with the best practices rather than by inspecting individual cases to identify erroneous treatment," according to the CMS notice.
In June 2000, the Department of Health and Human Services Office of Inspector General issued a report stating that the monitoring of the nation's key dialysis facilities has "major shortcomings," and recommended that greater accountability was needed to ensure higher quality care (11 MCR 695, 7/7/00). An inspection report by the IG in February 2002 restated that conclusion (13 MCR 177, 2/15/02).
In the notice, CMS said the changes will not have a major economic effect. As a result, the criteria changes are not classified as a "major rule."
The 60-day comment period ends Aug. 27. Comments should be sent to CMS, Department of Health and Human Services, Attention: CMS-3082-NC, P.O. Box 3016, Baltimore, Md. 21244-3016.
