After a year and a half of bitter wrangling, the Health and Human Services Department yesterday published final regulations to reduce Medicare payments for outpatient kidney dialysis, saving HHS an estimated $180 million in fiscal 1984.
The new payment levels are similar to those first proposed in February, 1982, and bitterly criticized as too low by officials of National Medical Care, a Boston-based firm that runs 160 independent clinics.
An official of the firm said yesterday that its head, Dr. Constantine Hampers, still thinks the payment for independent clinics, which is lower than the figure for hospitals, will make it impossible for some clinics to stay open.
But he said the firm has improved its efficiency and is "not as pessimistic" as it was two years ago. On the other hand, several congressional health experts are said to believe that the payment figure for the clinics is too close to that for hospitals, where costs have traditionally been higher.
The new regulations provide that beginning Aug. 1, hospitals providing outpatient dialysis will receive an average of $131 per treatment and independent clinics $127, athough some institutions may receive slightly more or less depending on local labor costs.
Previously, the hospital payment was limited to $138, but so many exceptions were allowed that the average hospital reimbursement was $166.
Medicare will pay 80 percent of the new figures, and the institution must collect the rest from the patient, the patient's private insurance or state agencies that help such patients.
The average figures will apply even where the hospital or clinic is supervising the care of a patient who is being dialyzed at home where costs are cheaper (about $97), a feature intended to induce hospitals and clinics to encourage more patients to dialyze at home, enabling the costs of the system to be lowered.
The regulations will establish a single monthly doctor payment figure to encourage doctors to treat patients at home instead of institutions, where they used to receive a higher fee.