2006 proposed fee schedule - American Society of Clinical Oncology

will ensure that the level of aggregate payments to ESRD
facilities is maintained. We note that our proposal to
allow some facilities to move directly to the new wage-
170
adjusted composite rate will have some impact on the level
of the budget neutrality adjustment. However, we estimate
that the overall effect on total payments to facilities
would not be significant. For example, the impact on
aggregate payments to rural facilities would be a decrease
of about 0.2 percent and an increase of about 0.1 percent
for urban facilities. This occurs because all of the
facilities that are currently subject to the 1.300 wage
index cap are located in urban areas.
We also considered alternative approaches for
transitioning facilities to the proposed updated wage
adjustments. Another approach would be to apply the
proposed 50-50 transition to all facilities, whether or not
they do better using the updated wage index adjustment.
This approach would treat all facilities equally for
transition purposes, but would mean that those facilities
that are currently underpaid because of the current outdated
wage index adjustment would have to wait until the
transition was completed to receive the higher payment to
which they are entitled.
An alternative to the proposed two-year transition
would be to adopt a three-year transition. This would allow