How dialysis is paid for: what the dialysis medical director should know, and why.

While Medicare funds neither 100% of the patients, nor 100% of the costs incurred by dialysis patients, Medicare's policies dominate reimbursement. The medical director is well advised to understand these mechanisms and the processes leading to change. Medicare pays for dialysis according to laws and rules enacted by Congress. Congress is re-evaluating the funding of the end-stage renal disease program. The rules are changing. They are changing in a way designed to encourage better outcomes, and increased provider accountability. The new terms of art are "budget neutrality,""quality incentive payments," and "bundled composite rate." Providers will need to make choices that may impact the quality of care and the experience of the patient. It is up to the medical director to ensure that these choices result in benefit to their patients.