Bundling Effectiveness In the United States alone, more than 366,000 people diagnosed with end-stage renal disease (ESRD) rely on kidney dialysis as a life-sustaining treatment (Collins, Foley, Gilbertson and Chen, 2009). The majority of these patients resort to expensive in-center hemodialysis (HD) three times a week to filter their blood during four-hour sessions. Since 1972, Medicare has covered the costs of dialysis for patients as well as the separately billed, frequently used drugs that are part of treatments for end-stage kidney disease. The annual cost of this coverage revealed a shocking $77,506 for each person requiring chronic hemodialysis care (Iglehart, 2011). As part of the government's efforts to limit the rising cost of dialysis treatments, the new grouping guidelines took effect January 1, 2011. Description of the organization Renal Care Partners is a small group of dialysis clinics headquartered social is in Florida. Each clinic will have assumed a different partnership with the doctors who are shareholders of the clinic. As a result, each clinic may have unit-specific policy and procedures that reflect nephrologists' involvement in the company's financial situation. In general, charitable giving as a business is rare. In the past, RCP has participated in the National Kidney Foundation's Kidney Walk event. Few employees, individually, offered their services and donated funds to raise awareness of chronic kidney disease. Additionally, HR, as administrator, has managed the clinic for the past eight years working closely with Virginia Nephrology Group physicians. She managed the clinic's fourteen employees while...... middle of paper......, if dialysis fees exceed those of the bundled rate, dialysis centers must absorb the excess cost. Thus, dialysis clinics will be governed by a Quality Incentive Program (PQ). Clinical outcome measures related to anemia management and dialysis adequacy will be evaluated against past clinic performance or national dialysis standards. Beginning in 2012, clinic failure to meet QIP standards will result in a penalty of up to 2% of payment reductions (Iglehart, 2011). This display of vigilance on the part of CMS suggests its concerns about quality measurement in the midst of a national health care budget crisis. In conclusion, dialysis clinics can successfully address financial constraints by modifying business infrastructure to reflect clinical effectiveness and expanding the home PP program..