Yes, phosphorus binders are planned to be included in bundled payments by the Centers for Medicare & Medicaid Services (CMS) starting in 2025.
Current Status of Phosphorus Binders in Bundled Payments
Currently, drugs known as phosphorus binders (also referred to as phosphate binders), which are commonly used by patients with kidney disease, are not part of the bundled payment system. This means that these medications are typically reimbursed separately from the comprehensive dialysis treatment bundle.
Future Inclusion and Timeline
The Centers for Medicare & Medicaid Services (CMS) has outlined plans to integrate phosphorus binders into the bundled payment system. This change is projected to take effect in 2025. This move signifies a shift towards a more comprehensive bundled payment model for renal care, aiming to incorporate all related services and medications into a single payment.
Understanding the Transition
| Aspect | Current Status (Pre-2025) | Planned Status (2025 Onward) |
|---|---|---|
| Inclusion in Bundle | Not included | Yes, will be included |
| Responsible Authority | N/A (Reimbursed separately) | Centers for Medicare & Medicaid Services (CMS) |
| Impact on Dialysis Organizations | N/A (Separate dispensing/billing) | May require expanded capacity for dispensing |
What Are Phosphorus Binders?
Phosphorus binders are medications prescribed to individuals with chronic kidney disease (CKD), particularly those on dialysis. Their primary function is to bind to excess phosphorus in the diet, preventing its absorption into the bloodstream. High levels of phosphorus can lead to serious health complications, including bone disease and cardiovascular problems.
Implications for Dialysis Organizations
The planned inclusion of phosphorus binders in the bundled payment system starting in 2025 carries significant implications for dialysis organizations. As these organizations will become responsible for dispensing these high-volume drugs as part of the bundle, they may need to:
- Expand Dispensing Capacity: Invest in infrastructure, personnel, and inventory management systems to handle the increased volume of medications dispensed directly to patients.
- Adjust Operational Models: Integrate drug dispensing into their existing workflows, ensuring efficiency and patient access.
- Financial Planning: Re-evaluate their financial models to account for the costs associated with purchasing and dispensing phosphorus binders, as these will now be covered under a fixed bundled payment.
This change aims to streamline care and potentially incentivize more integrated management of patients' needs within the bundled payment structure.
