Commenting today on a proposed rule bundling Medicare payments for all services related to an outpatient dialysis session, the AHA said the proposed unit of payment, outlier payment policy for high-cost services and quality measures "are reasonable and will help to ensure continued appropriate care in hospital-based settings." The association expressed concern with a proposal to include in the payment bundle certain oral drugs currently paid separately under Medicare Part D; the lack of a specific list of diagnostic laboratory tests contained in the bundle; and the proposal to bundle the costs of home dialysis training into the end-stage renal disease prospective payment system. In addition, it said the threshold proposed for the low-volume adjustment should be increased to accommodate additional providers, and the proposed ESRD PPS should be postponed for pediatric patients. "The AHA is seriously concerned about CMS' impact analysis indicating that programs with mostly pediatric patients will see an 11.7% reduction in reimbursement," the comment letter states.