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Rob Blaser @robertblaser.bsky.social · 05/05/2026

They’ll never get another one for their sports coverage

and aid the transplantation of medically complex kidneys. We'll keep digging into this massive legislation and will keep the kidney community apprised as appropriate. (4/end)

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and several organ donation/transplantation provisions that would, among other things, support the adoption of real-time organ tracking during transit, (3)

extension of the Geographic Practice Cost Indices (GPCI) floor of 1.0 for rural areas, a 3.1% alternate payment model (APM) bonus for qualifying participants for performance year 2026, (2)

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Rob Blaser @robertblaser.bsky.social · 03/12/2025

Folks, I know a lot of people already know about this but the FY2026 appropriations bill included a health package with key provisions for nephrology. Among these provisions was a two-year extension of current telehealth flexibilities (until December 31, 2027 (1)

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Rest assured that RPA is tracking developments and will keep the nephrology community updated on what happens. (3/end)

Rob Blaser @robertblaser.bsky.social · 03/12/2025

The initial announcement is intriguing but the real proof-is-in-the-pudding details won't be known until the Agency releases a request for application (RFA) that includes enrollment, implementation, operational, and other details. (2)

Rob Blaser @robertblaser.bsky.social · 03/12/2025

Good morning people. I know many folks have heard about the new CMS/CMMI ACCESS Payment Model (link below) that seeks to leverage digital and technological assets to help manage and delay the onset of chronic disease. (1) www.cms.gov/priorities/i...

cms.gov

ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model | CMS

The ACCESS Model tests an outcome-aligned payment approach in Original Medicare to expand access to new technology-supported care options that help people improve their health and prevent and manage c...

Rob Blaser @robertblaser.bsky.social · 12/11/2025

The other extender package items (GPCI floor and low volume hospital payments, for example) will be handled similarly. RPA will keep on top of this and keep the nephrology/kidney policy community advised in as real-time a manner as possible. Take care and be kind to others. (2/end).

Rob Blaser @robertblaser.bsky.social · 12/11/2025

I realize folks have probably heard this elsewhere, but it looks like the shutdown will likely end very soon, if not tonight then tomorrow. The good health policy news is that the telehealth flexibilities will be extended until January 30 and made retroactive back to October 1. (1)

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More to come, Happy Halloween. (8/end).

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Recall that this is the first year of the two-conversion factor system mandated by MACRA that gives a higher bonus for qualifying APM participants and a lower increase for non-qualifying Medicare Part B providers. (7)

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"Similarly, the final CY 2026 nonqualifying APM conversion factor of $33.40 represents a projected increase of $1.05 (+3.26%) from the current conversion factor of $32.35.” (6)

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Regarding the conversion factor, this too is unchanged from what was proposed; per the CMS press release on the rule, “the final CY 2026 qualifying APM conversion factor of $33.57 represents a projected increase of $1.22 (+3.77%) from the current conversion factor of $32.35. (5)

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Accordingly, changes to the dialysis code family and to E&M codes are as proposed in July, healthy increases for outpatient E&M services/corresponding cuts to I/P E&M codes. One change made to the efficiency adjustment proposal is to exempt new codes from the adjustment. (4)

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Thus, the -9.4% hit for (for example) CPT code 90935 (inpatient dialysis) and the +9.0 increase for 90960 (adult monthly dialysis) are still as proposed. (3)

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So, nephrology is still slated to have a projected impact of +1%, and the inpatient/outpatient dichotomy is in July, as the methodological changes for the work RVUs (via the efficiency adjustment) and the practice expense RVUs (via changes to indirect PEs) are still in place. (2)

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Rob Blaser @robertblaser.bsky.social · 16/10/2025

Folks, the final rule for the 2026 Medicare Fee Schedule was released tonight, and it appears to have been finalized almost exactly as it was proposed. (1)

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The MLN post ended up being correct, CMS issued a clarification last night that aligned with the MLN post and thus the vast majority of claims will be paid as scheduled.

Rob Blaser @robertblaser.bsky.social · 16/10/2025

Great question. There was much communication (confusion?) yesterday that all payments were paused per a CMS announcement, but the original Medicare Learning Network (MLN) post said it only claims for expiring provisions were being held, like those for telehealth. (1)

Rob Blaser @robertblaser.bsky.social · 15/10/2025

Very kind Charlotte, thank you. Great seeing you and I hope you had an uneventful trip home.

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Rob Blaser @robertblaser.bsky.social · 10/10/2025

@rpanephrology leaders strategizing about RPA’s Capitol Hill Day tomorrow. Over drinks.

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So, given the good chance that a Medicare extenders package happens before say year's end, the flexibilities should be extended then. Stay tuned. (4/end)

Whether that lasts for days/weeks/months no one knows, but practices should be adjusting their schedules accordingly. The positive news IMO is that everyone on the Hill seems to agree that the telehealth flexibilities should be extended if not made permanent. (3)

While I was pretty bullish that this would get resolved prior to 9/30 earlier this year, now it looks pretty likely that there will be a lapse in the flexibilities with an almost certain government shutdown. (2)

Folks, there is a lot of chatter among nephrology practices about whether the telehealth flexibilities and thus the ability to provide services via those means will end on September 30. (1)

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Rob Blaser @robertblaser.bsky.social · 18/09/2025

Charlotte, the chances of it getting resolved by September 30 are slim to nonexistent. My guess is the flexibilities will be extended by years’ end but when that happens, who knows?

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NEPHROLOGY NURSES, YOU ROCK!!! Happy Nephrology Nurses Week to all of the heroes out there providing great care to persons with kidney disease, can't wait to spend time with our friends at the American Nephrology Nurses Association next week. Thanks for everything y'all do!

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Reposted by Rob Blaser

Jason Kander @jasonkander.bsky.social · 23/07/2025

You know that scene in an action movie when the bad guy runs through the kitchen of a restaurant and pulls down all the pots and pans behind him to slow down his pursuers? We're in that part of the Trump presidency.

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Folks, there was a error in my MFS post this A.M., the 'all others' CF increase for 2026 will be about $3.30, not $3.62. The 2nd figure ($3.62) was from the CMS Newsroom press release on the rule, but that's no excuse, I should have double checked the math. Sorry about that.

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Comments on the proposed rule are due on September 12. (12/end).

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creation of a new payment model focused on heart failure and low back pain, a change to the Medicare Diabetes Prevention Program to facilitate greater access to the program, and an effort to reduce Medicare spending on skin substitutes, among others. (11)

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Those are the foundational changes this year, there are of course numerous other proposals (it's an 1800 page rule), on telehealth (but not about extension of the current flexibilities, Congress has to do that), (10)

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On a code-specific level, CPT code 90935 (hemodialysis, single evaluation), is slated for a 9.4% cut, while the four visit adult outpatient dialysis capitated service (CPT code 90960) is set for a 9.0% increase. (9)

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Using nephrology as an example of the impact of the RVU changes, while the specialty nets out at a +1% overall impact, on the inpatient side there is a projected 9% payment cut, while outpatient are expected to increase by 7%. (8)

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$33.59 for those qualifying participants in APMs, $33.42 for all others. Recall that the 2025 CF is $32.35, so the 2026 APM-based CF will be a 3.83% increase over the 2025 CF, while the ‘all others’ CF will be increased by 3.62%. (7)

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Regarding the 2026 CFs, they include a 0.75% increase for APM participants and a 0.25% increase for all others, the 2.5% increase enacted in the One Big Beautiful Bill (H.R. 1) and also an upward budget neutrality adjustment of 0.55%. All of this results in 2026 CFs of: (6)

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and (2) a reduction of the the allocation of indirect costs for PE RVUs in the facility setting that CMS believes is more reflective of current medical practice. (5)

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while outpatient services and primary care will see nearly equal increases in value and payment. CMS' changes that are the catalysts for these revisions are (1) use of an efficiency adjustment on work RVUs that reduces the impact of the survey process used to develop RVUs, (4)

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The other big headline is that due to fundamental methodological changes affecting development and implementation of changes to relative value units (RVUs), inpatient services and many procedures will see steep reductions in value and payment in 2026, (3)

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and Part B provider reimbursement is adjusted up or down every year); the two CFs are for (1) physicians who are part of Medicare APMs, and (2) for all others. Implementation of two CFs was legislatively mandated and long in the planning, but it is still a major deal. (2)

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Folks, the proposed rule for the 2026 Medicare Fee Schedule came out on Monday, with two primary headlines. The first is that there are now two conversion factors (CFs--with the conversion factor being the multiplier expressed as a dollar figure through which physician (1)

Morgan J Freeman @mjfree.bsky.social · 16/07/2025

Reposted by Rob Blaser

I’m gonna post this every day so nobody forgets exactly who Pedophile Trump is and why the Epstein files have suddenly disappeared.

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from the ESRD QIP measure set beginning with Payment Year (PY) 2027. Comments on the proposed ESRD PPS rule are due on or around August 29. (6/end).

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In the ESRD QIP section, the rule proposes eliminating three health equity reporting measures, including the Facility Commitment to Health Equity reporting measure, the Screening for Social Drivers of Health reporting measure, and the Screen Positive Rate for Social Drivers of Health measure (5)

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This includes removal of all six questions that make up the Nephrologists’ Communication and Caring (NCC) multi-item measure and removal of the nephrologist rating question. The rule also consolidates the race and ethnicity questions into one question. (4)

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The rule also proposes to shorten the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey to 39 questions, removing 23 questions. (3)

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