The Centers for Medicare & Medicaid Services yesterday issued a final rule implementing a Medicare bundled payment system for all services related to an outpatient dialysis session, and a proposed rule reducing payment rates by up to 2.0% if a facility fails to meet certain quality performance measures. The ESRD bundled prospective payment system takes effect in January 2011 for dialysis services provided to Medicare beneficiaries with end-stage renal disease. It provides a single bundled payment for each dialysis treatment, which includes dialysis and supplies, related clinical laboratory tests, certain related drugs, and a payment adjustment for home dialysis training when clinically appropriate. The final rule sets a base payment rate of $229.63 for each dialysis treatment, which would be adjusted for case mix, new patients, pediatric patients, co-morbidities, low-volume facilities, geographic wage index, dialysis training treatments for home or self dialysis and high-cost "outlier" cases. The final rule also postpones until Jan. 1, 2014 the inclusion of ESRD-related oral-only drugs under the ESRD PPS. The proposed Value Based Purchasing (or pay-for-performance) system, the first in a Medicare fee-for-service program, would take effect in January 2012 for three quality measures, related to anemia management and hemodialysis adequacy. CMS will accept comments on the proposed value-based purchasing rule through Sept. 24.