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 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.

2 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 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) 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)

3 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: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.

4 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). 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.

5 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. 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.

6 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, 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.

7 486609 BACTERIUM ANTIBODYXXI nfection1,2,3,487040 BLOOD CULTURE FOR BACTERIAXXI nfection1,2,3,487045 FECES CULTURE, BACTERIAXXI nfection1,2,3,487046 STOOL CULTR, BACTERIA, EACHXXI nfection1,2,3,487070 CULTURE, BACTERIA, OTHERXXI nfection1,2,3,487071 CULTURE BACTERI AEROBIC OTHRXXI nfection1,2,3,487073 CULTURE BACTERIA ANAEROBICXXI nfection1,2,3,487076 CULTURE ANAEROBE IDENT, EACHXXI nfection1,2,3,4 Source: KECCB undle DefinitionsPage 4 of 143 Bundled Drugs and Laboratory TestsPreliminary - March 11, 2005 Included in bundle:HCPCS Name1A1B1C UseNotes87077 CULTURE AEROBIC IDENTIFYXXI nfection1,2,3,487081 CULTURE SCREEN ONLYXXI nfection1,2,3,487086 URINE CULTURE/COLONY COUNTXXI nfection1,2,3,487088 URINE BACTERIA CULTUREXXI nfection1,2,3,487147 CULTURE TYPE, IMMUNOLOGICXXI nfection1,2,3,487181 MICROBE SUSCEPTIBLE, DIFFUSEXXI nfection1,2,3,487184 MICROBE SUSCEPTIBLE, DISKXXI nfection1,2,3,487185 MICROBE SUSCEPTIBLE, ENZYMEXXI nfection1,2,3,487186 MICROBE SUSCEPTIBLE, MICXXI nfection1,2,3,487205 SMEAR, GRAM STAINXXI nfection1,2,3,489050 BODY FLUID CELL COUNTXXI nfection1,2,3,482108 ASSAY OF ALUMINUMXXL evocarnitine1,2,3,4,582270 TEST FOR BLOOD, FECESXXL evocarnitine1,2,3,4,582379 ASSAY OF CARNITINEXXL evocarnitine1,2,3,4,582530 CORTISOL, FREEXXL evocarnitine1,2,3,4,585651 RBC SED RATE, NONAUTOMATEDXXL evocarnitine1,2,3,4,585652 RBC SED RATE, AUTOMATEDXXL evocarnitine1,2,3,4,586140C-REACTIVE PROTEINXXL evocarnitine1,2,3,4,586141C-REACTIVE PROTEIN, HSXXL evocarnitine1,2,3,4.

8 586320 SERUM IMMUNOELECTROPHORESISXXL evocarnitine1,2,3,4,586850 RBC ANTIBODY SCREENXXL evocarnitine1,2,3,4,580048 BASIC METABOLIC PANELX80051 ELECTROLYTE PANELX80053 COMPREHEN METABOLIC PANELX80061 LIPID PANELX80069 RENAL FUNCTION PANELX80076 HEPATIC FUNCTION PANELX80100 DRUG SCREEN, QUALITATE/MULTIX80101 DRUG SCREEN, SINGLEX80150 ASSAY OF AMIKACINX80152 ASSAY OF AMITRIPTYLINEX80154 ASSAY OF BENZODIAZEPINESX80156 ASSAY, CARBAMAZEPINE, TOTALX80158 ASSAY OF CYCLOSPORINEX80162 ASSAY OF DIGOXINX80164 ASSAY, DIPROPYLACETIC ACIDX80170 ASSAY OF GENTAMICINX80178 ASSAY OF LITHIUMX80184 ASSAY OF PHENOBARBITALX80185 ASSAY OF PHENYTOIN, TOTALX80186 ASSAY OF PHENYTOIN, FREEX80188 ASSAY OF PRIMIDONEX80190 ASSAY OF PROCAINAMIDEX80194 ASSAY OF QUINIDINEX80196 ASSAY OF SALICYLATEX80197 ASSAY OF TACROLIMUSX80198 ASSAY OF THEOPHYLLINEX80200 ASSAY OF TOBRAMYCINX80299 QUANTITATIVE ASSAY, DRUGXS ource: KECCB undle DefinitionsPage 5 of 143 Bundled Drugs and Laboratory TestsPreliminary - March 11, 2005 Included in bundle.

9 HCPCS Name1A1B1C UseNotes81000 URINALYSIS, NONAUTO W/SCOPEX81003 URINALYSIS, AUTO, W/O SCOPEX81015 MICROSCOPIC EXAM OF URINEX82003 ASSAY OF ACETAMINOPHENX82024 ASSAY OF ACTHX82040 ASSAY OF SERUM ALBUMINX82042 ASSAY OF URINE ALBUMINX82043 MICROALBUMIN, QUANTITATIVEX82055 ASSAY OF ETHANOLX82085 ASSAY OF ALDOLASEX82088 ASSAY OF ALDOSTERONEX82103 ALPHA-1-ANTITRYPSIN, TOTALX82104 ALPHA-1-ANTITRYPSIN, PHENOX82105 ALPHA-FETOPROTEIN, SERUMX82128 AMINO ACIDS, MULT QUALX82131 AMINO ACIDS, SINGLE QUANTX82140 ASSAY OF AMMONIAX82145 ASSAY OF AMPHETAMINESX82150 ASSAY OF AMYLASEX82157 ASSAY OF ANDROSTENEDIONEX82164 ANGIOTENSIN I ENZYME TESTX82172 ASSAY OF APOLIPOPROTEINX82180 ASSAY OF ASCORBIC ACIDX82232 ASSAY OF BETA-2 PROTEINX82247 BILIRUBIN, TOTALX82248 BILIRUBIN, DIRECTX82252 FECAL BILIRUBIN TESTX82300 ASSAY OF CADMIUMX82340 ASSAY OF CALCIUM IN URINEX82365 CALCULUS SPECTROSCOPYX82374 ASSAY, BLOOD CARBON DIOXIDEX82378 CARCINOEMBRYONIC ANTIGENX82384 ASSAY, THREE CATECHOLAMINESX82390 ASSAY OF CERULOPLASMINX82435 ASSAY OF BLOOD CHLORIDEX82436 ASSAY OF URINE CHLORIDEX82465 ASSAY, BLD/SERUM CHOLESTEROLX82491 CHROMOTOGRAPHY, QUANT, SINGX82492 CHROMOTOGRAPHY, QUANT, MULTX82520 ASSAY OF COCAINEX82525 ASSAY OF COPPERX82533 TOTAL CORTISOLX82542 COLUMN CHROMOTOGRAPHY, QUANTX82550 ASSAY OF CK (CPK)X82552 ASSAY OF CPK IN BLOODX82565 ASSAY OF CREATININEX82570 ASSAY OF URINE CREATININEX82575 CREATININE CLEARANCE TESTX82626 DEHYDROEPIANDROSTERONEXS ource: KECCB undle DefinitionsPage 6 of 143 Bundled Drugs and Laboratory TestsPreliminary - March 11, 2005 Included in bundle.

10 HCPCS Name1A1B1C UseNotes82670 ASSAY OF ESTRADIOLX82672 ASSAY OF ESTROGENX82679 ASSAY OF ESTRONEX82784 ASSAY OF GAMMAGLOBULIN IGMX82785 ASSAY OF GAMMAGLOBULIN IGEX82787 IGG 1, 2, 3 OR 4, EACHX82941 ASSAY OF GASTRINX82945 GLUCOSE OTHER FLUIDX82947 ASSAY, GLUCOSE, BLOOD QUANTX82950 GLUCOSE TESTX82951 GLUCOSE TOLERANCE TEST (GTT)X82952 GTT-ADDED SAMPLESX82985 GLYCATED PROTEINX83001 GONADOTROPIN (FSH)X83002 GONADOTROPIN (LH)X83036 GLYCATED HEMOGLOBIN TESTX83050 BLOOD METHEMOGLOBIN ASSAYX83090 ASSAY OF HOMOCYSTINEX83519 IMMUNOASSAY, NONANTIBODYX83520 IMMUNOASSAY, RIAX83525 ASSAY OF INSULINX83615 LACTATE (LD) (LDH) ENZYMEX83625 ASSAY OF LDH ENZYMESX83655 ASSAY OF LEADX83690 ASSAY OF LIPASEX83715 ASSAY OF BLOOD LIPOPROTEINSX83718 ASSAY OF LIPOPROTEINX83719 ASSAY OF BLOOD LIPOPROTEINX83735 ASSAY OF MAGNESIUMX83825 ASSAY OF MERCURYX83840 ASSAY OF METHADONEX83872 ASSAY SYNOVIAL FLUID MUCINX83874 ASSAY OF MYOGLOBINX83890 MOLECULE ISOLATEX83892 MOLECULAR DIAGNOSTICSX83898 MOLECULE NUCLEIC AMPLIX83912 GENETIC EXAMINATIONX83915 ASSAY OF NUCLEOTIDASEX83925 ASSAY OF OPIATESX83935 ASSAY OF URINE OSMOLALITYX83986 ASSAY OF BODY FLUID ACIDITYX84022 ASSAY OF PHENOTHIAZINEX84060 ASSAY ACID PHOSPHATASEX84066 ASSAY PROSTATE PHOSPHATASEX84132 ASSAY OF SERUM POTASSIUMX84133 ASSAY OF URINE POTASSIUMX84134 ASSAY OF PREALBUMINX84144 ASSAY OF PROGESTERONEX84146 ASSAY OF PROLACTINXS ource: KECCB undle DefinitionsPage 7 of 143 Bundled Drugs and Laboratory TestsPreliminary - March 11, 2005 Included in bundle.