Table 3.

Medicare Payment Advisory Commission underestimates true dialysis facility margins

Unallowable Cost Report ExpensesInadequate Reimbursement
Network $0.50 per treatment taxReimbursement for patients with 100% Medicaid varies by state; some states pay far less than the cost of treatment
Actual Medical Director salaries exceed regulatory limit for cost reportReimbursement for patients with 20% Medicaid varies by state; some states do not pay the full amount
Patients without 20% Medicare copay coverage; many states do not offer Medi-Gap insurance for patients<65 yr of age
Many patients cannot afford high copays and deductibles; results in provider bad debts for up to 9 mo/yr
Inability to collect all Medicare bad debts
2% pay cut from Medicare sequester not included in calculation