FMS and DVA were expecting $190 per treatment so ofcourse this is good. They were expecting all vendors to be forced to bundle from Jan 2011 , and then pickup more freestanding units at firesale prices. Under the bundling rule the units can either opt in for bundling or be gradually phased in till 2014. The bundled payment is good for home dialysis and the training is excluded from bundling. They will now be able to bill for training. At FMS they have been slow in converting patients to home dialysis. I think this will accelerate from Jan 2011. I do feel that peritoneal dialysis will get more converts than home hemo since with NXTM the patient has to dialyze 6 days a week. We will see some growth but also feel the big money has been made in NXTM and so I have cashed out.
Peritoneal sounds like a long shot to me. Permanent surgery and whether the patient is well enough to handle/recover from the surgery are problems for end stage kidney patients. Infection risk over time sounds bad too.
This is a helpful primer article (for me anyway) on how dialysis is paid for. Start under the heading "Medicare" if you wish to get to the meat of the article faster. The article is from 2007, and reimbursement percentages may have changed some (or a lot).
I found this article from September 2009. It outlines the items covered by CMS for home dialysis, and has some inputs from NXTM's CEO Burbank. Looks like some things have changed with the drugs not being part of the bundled CMS payment per treatment.