Physician Payment Rates Under Medicare's End Stage Renal Disease Program

GAO discussed the results of a questionnaire that it sent to physicians who provided renal services to beneficiaries of the Medicare End Stage Renal Disease (ESRD) program. GAO found that the Monthly Capitation Payment (MCP) which physicians received each month for treated ESRD patients was too high because the computation overstated physician involvement with patients dialyzing at home. GAO recomputed MCP using its data on relative physician involvement with home and facility patients and found that the Department of Health and Human Services (HHS): (1) had overstated MCP by an average of $14 per patient; and (2) could reduce annual MCP payments by about $11.8 million by using the lower ratio. These findings were the basis for the HHS MCP revision.