Bundled Payment Options: Data Tables

1 ESRD Bundled Payment OptionsIndex of Data TablesTablePageTable Key1 Bundle Defintions3 Drugs3 Laboratory Tests4 Table 0-1 Summary of Options: All Patients13 Table 0-2 Summary of Options: PD Patients15 Table 0-3 Summary of Options: HD Patients17 Table 0-4 Summary of Options: HD Patients / Full Month 19 Table 0-5 HD Equivalent Sessions21 Table 0-6 Composite Rate Services24 Table 1A-1 Bundle 1A Total MAC30 Table 1A-2 EPO and Aranesp36 Table 1A-3 Iron42 Table 1A-4 Vitamin D48 Table 1A-5 Anemia Lab Tests54 Table 1A-6 Vitamin D Lab Tests60 Table 1B-1 Bundle 1B Total MAC66 Table 1B-2 Levocarnitine72 Table 1B-3 Altaplase78 Table 1B-4 Vancomycin84 Table 1B-5 Infection Lab Tests90 Table 1B-6 Carnitine Lab Tests96 Table 1C-1 Bundle 1C Total MAC102 Table 1C-2 Other injectable drugs108 Table 1C-3 Other Lab Tests114 Table 1D-1 Bundle 1D Total MAC120 Table 1D-2 Other facility

2 Services126 Table 2A-1 Bundle 2A Total MAC132 Table 2A-2 Physician MCP138 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 second page displays statistics on payments per session for these same categories of third page displays statistics on payments per month for patients categorized patients by type of month and facility fourth page displays statistics on payments per session for these same categories of fifth page displays statistics on payments per month by renal sixth page displays statistics on payments per session by renal Bundled Payment OptionsIndex of Data TablesThe following map may be helpful to those not familiary with the states covered by the renal to reading tablesDefinition of bundle

3 Components and column headingsApril 1, 2005 PercentilePercent of:DescriptionObsMeanStd / ComponentsAll patientsPer monthPer monthHD-equivalent sessionsComposite rate servicesBundle 1A TotalEPO and AranespVitamin DIronAnemia LabsVitamin D LabsBundle 1B TotalLevocarnitineAlteplaseVancomycinInf ection LabsCarnitine LabsBundle 1C TotalBundle 1B Payment (including composite rate) plus sum of components listed in following rowsOther InjectablesHepatitis B vaccine, flu vaccine, cefazolin, ceftriaxone, cefazidime, heparin sodium and LabsAll other labs billed by the top 10 freestanding providers of laboratory services and not already 1D TotalBundle 1C Payment (including composite rate)

4 Plus sum of other facility servicesOther Facility ServicesAll other services billed by dialysis facilities not included in bundles 1A, 1B, or 1 CBundle 2A TotalBundle 1D Payment (including composite rate) plus MCP paymentPhysician MCPP hysician Medicare Capitation PaymentSee definitions for Bundle 1A at end of definitions for Bundle 1B at end of dependent variable, , sessions, composite rate payments, component paymentsNumber of HD sessions (for HD patients) or number of PD days multiplied by 3/7 (for PD patients)Composite rate Payment plus sum of components listed in following rowsBundle 1A Payment (including composite rate) plus sum of components listed in following rowsPayment under the composite rate systemTable KeyPage 1 of 143 Key to reading tablesDefinition of bundle components and column headingsApril 1, 2005 PercentilePercent of.

5 DescriptionObsMeanStd / ComponentsAll patientsPer sessionPer sessionHD-equivalent sessionsComposite rate servicesBundle 1A TotalEPO and AranespVitamin DIronAnemia LabsVitamin D LabsBundle 1B TotalLevocarnitineAlteplaseVancomycinInf ection LabsCarnitine LabsBundle 1C TotalOther InjectablesOther LabsBundle 1D TotalOther Facility ServicesBundle 2A TotalPhysician MCPI ndicates whether statistics in following rows are expressed on a per month or per session basisNumber of observations (patient months)Mean value of dependent variableStandard deviation of dependent variableCoefficient of variation (SD / Mean)Percentiles of dependent variableInterquartile range (75th/25th percentile)% of patient months with claims > 0% of patients with claims > 0 during yearTable KeyPage 2 of 143 Bundled Drugs and Laboratory TestsPreliminary - March 11, 2005 CategoryDrugHCPCS / Revenue Center (RC)2 CodesBundle 1A.

6 1 EPOE pogenRC 0634 or 0635, HCPCS Q9920 - Q9940 Darbepoetin alfaJ0880 IronIron dextranJ1750, J17603 Iron sucroseJ1756, J17553 Sodium ferric gluconateJ2916, J29153 UnclassifiedJ34904, W02335, X01075 Vitamin DCalcitrolJ0636, J06353 DoxercalciferolJ1270 ParicalcitolJ2501, J25003, W02375 Calcitonin salmon (indication-specific)J0630 Bundle 1 BLevocarnitineJ1955 Alteplase, recombinantJ2997 VancomycinJ3370 NotesBundle 1 BBundle 1B2 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).

7 Different codes could be used in other 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 These three types of injectables accounted for percent of Medicare payments to dialysis facilities for injectables during bundles: specification of a bundle in terms of specific codes could lead to substitution with other service codes that are not in the 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 Together with EPO, iron and vitamin D, the above three injectables accounted for percent of Medicare payments to dialysis facilities for injectables during This code is for unclassified drugs, but has been used to bill for iron as codes for new iron products were being developed.

8 This code accounts for less than percent of iron payments to dialysis facilities during These are local codes that were defined by certain fiscal intermediaries. These local codes account for percent of iron payments and percent of vitamin D payments to dialysis facilities during 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 : KECCB undle DefinitionsPage 3 of 143 Bundled Drugs and Laboratory TestsPreliminary - March 11, 2005 Included in bundle.

9 HCPCS Name1A1B1C UseNotes82607 VITAMIN B-12 XXAnemia182608B-12 BINDING CAPACITYXXA nemia182668 assay OF ERYTHROPOIETINXXA nemia182728 assay OF FERRITINXXA nemia182746 BLOOD FOLIC ACID SERUMXXA nemia182747 assay OF FOLIC ACID, RBCXXA nemia182955 assay OF G6PD ENZYMEXXA nemia182960 TEST FOR G6PD ENZYMEXXA nemia183010 assay OF HAPTOGLOBIN, QUANTXXA nemia183020 HEMOGLOBIN ELECTROPHORESISXXA nemia183021 HEMOGLOBIN CHROMOTOGRAPHYXXA nemia183030 FETAL HEMOGLOBIN, CHEMICALXXA nemia183051 assay OF PLASMA HEMOGLOBINXXA nemia183540 assay OF IRONXXA nemia183550 IRON BINDING TESTXXA nemia184466 assay OF TRANSFERRINXXA nemia185014 HEMATOCRITXXA nemia1, 285018 HEMOGLOBINXXA nemia1.

10 285041 AUTOMATED RBC COUNTXXA nemia185044 MANUAL RETICULOCYTE COUNTXXA nemia185045 AUTOMATED RETICULOCYTE COUNTXXA nemia185046 RETICYTE/HGB CONCENTRATEXXA nemia185660 RBC SICKLE CELL TESTXXA nemia186340 INTRINSIC FACTOR ANTIBODYXXA nemia186870 RBC ANTIBODY IDENTIFICATIONXXA nemia182306 assay OF VITAMIN DXXV itamin D182308 assay OF CALCITONINXXV itamin D182310 assay OF CALCIUMXXV itamin D182652 assay OF DIHYDROXYVITAMIN DXXV itamin D182977 assay OF GGTXXV itamin D183500 assay , FREE HYDROXYPROLINEXXV itamin D183937 assay OF OSTEOCALCINXXV itamin D183970 assay OF PARATHORMONEXXV itamin D184075 assay ALKALINE PHOSPHATASEXXV itamin D184080 assay ALKALINE PHOSPHATASESXXV itamin D184100 assay OF PHOSPHORUSXXV itamin D180202 assay OF VANCOMYCINXXI nfection1,2,381001 URINALYSIS, AUTO W/SCOPEXXI nfection1,2,3,485025 COMPLETE CBC W/AUTO DIFF WBCXXI nfection1,2,3,485048 AUTOMATED LEUKOCYTE COUNTXXI nfection1,2,3,486317 IMMUNOASSAY,INFECTIOUS AGENTXXI nfection1,2,3,486609 BACTERIUM ANTIBODYXXI nfection1,2,3,487040 BLOOD CULTURE FOR BACTERIAXXI nfection1,2,3,487045 FECES CULTURE, BACTERIAXXI nfection1,2,3.