Bill - while I didn’t go back and read all those posts from last year I too have recently read about bundling. Wrong move! Wrong, wrong, wrong! And you are right, it’s all about EPO. What gets my goat is that our congress is really so out of touch with reality these days. With a 15 - 25% approval rating they better wake up! If we, as health care providers, bundle all services into the composite rate get ready for a serious breach in delivery of patient care. Being a dialysis RN for 21 years now, I remember those Hct’s of 18 -21 and transfusions everywhere. I shudder to think of just the antibody levels for pts waiting for transplant with high PRA’s. I hope to God this doesn’t happen.
If testimony at this hearing doesn’t reflect your thinking, you still have time to submit your own testimony. You could include your experience with low (<11) or high (>12) hemoglobin levels, whether you get your EPO IV or subcutaneously, your dose, what happens when your EPO is stopped vs. reduced, your activity level, etc. Express your thoughts about whether you think bundling would improve or hurt care that patients like you receive and explain why you think this. The deadline to submit written testimony is close of business July 10 (I assume this is 5 p.m. EDT).
ADVISORY
FROM THE COMMITTEE ON WAYS AND MEANS
SUBCOMMITTEE ON HEALTH
FOR IMMEDIATE RELEASE
June 26, 2007
HL-15
CONTACT: (202) 225-3943
Stark Announces a hearing on Ensuring Kidney Patients Receive Safe and Appropriate Anemia Management Care
House Ways and Means Health Subcommittee Chairman Pete Stark (D-CA) announced today that the Subcommittee on Health will hold a public hearing on safety concerns regarding the dosing of erythropoiesis stimulating agents (ESAs), variations in utilization of ESAs across providers, and reimbursement issues. The hearing will take place at 10 a.m. on Tuesday, June 26, 2007, in Room 1100, Longworth House Office Building.
In view of the limited time available to hear witnesses, oral testimony at this hearing will be from the invited witness only. However, any individual or organization not scheduled for an oral appearance may submit a written statement for consideration by the Committee and for inclusion in the printed record of the hearing.
BACKGROUND:
The Medicare program began covering treatment for patients with End Stage Renal Disease (ESRD) beginning in 1972. According to the U.S. Renal Data System (USRDS), the dialysis population reached nearly 336,000 patients in 2004 at a cost of $20.1 billion. This amounts to a 57 percent increase in Medicare ESRD spending since 1999. In 2004, the average annual cost per Medicare beneficiary was $58,000.
When a patient’s kidneys stop working, as is the case with ESRD patients, they often cannot produce enough of the hormone erythropoietin, which helps the body produce red blood cells. As a result, these patients suffer from anemia. Synthetic versions of erythropoietin are collectively referred to as erythropoiesis stimulating agents (ESAs), which are sold in the U.S. under the brand names of Epogen, Procrit, and Aranesp.
Dialysis care has made great strides in treating anemia, and this achievement is directly linked to significant increases in doses of ESAs. Dosing levels increased dramatically in recent years, with average weekly dose of ESAs increasing nearly 4,000 units between 2000 and 2004. Medicare spending for ESAs increased by 17 percent from 2003 to 2004 alone, up to $1.8 billion. Spending on ESAs per person per month is now nearly one-half of the monthly cost for dialysis.
While ESAs are critical to treatment of anemia for ESRD patients, higher doses that raise red blood cells above a certain threshold have been found to pose significant health risks to patients. The Food and Drug Administration (FDA) recently issued a black box label warning of risk of blood clots, strokes, heart failure and heart attacks in kidney patients in such circumstances. Furthermore, as both the Medicare Payment Advisory Commission and the Government Accountability Office point out, there are flaws in the current Medicare reimbursement system. The existing Medicare payment system incentivizes higher doses in certain circumstances, with resulting health risks and higher costs for beneficiaries and taxpayers.
“My priority for Medicare ESRD policy is to ensure patient safety while also protecting taxpayers from unnecessary expenditures,” stated Chairman Stark in announcing the hearing. “Health risks associated with higher doses and well-documented flaws in a payment system that encourages higher dosing highlights that this issue is ripe for reexamination. We must do better for our ESRD beneficiaries and for the taxpayers.”
FOCUS OF THE HEARING
The hearing will focus on the safety concerns regarding dosing of ESAs for ESRD, variations in utilization of ESAs across providers, and issues related to reimbursement.
DETAILS FOR SUBMISSION OF WRITTEN COMMENTS:
Please Note: Any person(s) and/or organization(s) wishing to submit for the hearing record must follow the appropriate link on the hearing page of the Committee website and complete the informational forms. From the Committee homepage, http://waysandmeans.house.gov, select “110th Congress” from the menu entitled, “Committee Hearings” (http://waysandmeans.house.gov/Hearings.asp?congress=18). Select the hearing for which you would like to submit, and click on the link entitled, “Click here to provide a submission for the record.” Once you have followed the online instructions, completing all informational forms and clicking “submit” on the final page, an email will be sent to the address which you supply confirming your interest in providing a submission for the record. You MUST REPLY to the email and ATTACH your submission as a Word or WordPerfect document, in compliance with the formatting requirements listed below, by close of business Tuesday, July 10, 2007. Finally, please note that due to the change in House mail policy, the U.S. Capitol Police will refuse sealed-package deliveries to all House Office Buildings. For questions, or if you encounter technical problems, please call (202) 225-1721.
FORMATTING REQUIREMENTS:
The Committee relies on electronic submissions for printing the official hearing record. As always, submissions will be included in the record according to the discretion of the Committee. The Committee will not alter the content of your submission, but we reserve the right to format it according to our guidelines. Any submission provided to the Committee by a witness, any supplementary materials submitted for the printed record, and any written comments in response to a request for written comments must conform to the guidelines listed below. Any submission or supplementary item not in compliance with these guidelines will not be printed, but will be maintained in the Committee files for review and use by the Committee.
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All submissions and supplementary materials must be provided in Word or WordPerfect format and MUST NOT exceed a total of 10 pages, including attachments. Witnesses and submitters are advised that the Committee relies on electronic submissions for printing the official hearing record.
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Copies of whole documents submitted as exhibit material will not be accepted for printing. Instead, exhibit material should be referenced and quoted or paraphrased. All exhibit material not meeting these specifications will be maintained in the Committee files for review and use by the Committee.
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All submissions must include a list of all clients, persons, and/or organizations on whose behalf the witness appears. A supplemental sheet must accompany each submission listing the name, company, address, and telephone and fax numbers of each witness.
Note: All Committee advisories and news releases are available on the World Wide Web at http://waysandmeans.house.gov.
Testimony matters. I was in DC yesterday and I heard the plan is to cut 1 to 1.5 billion from the Part B side of the ESRD program. The money will be taken from the dialysis program to help pay for a fix to the State Children’s Health Insurance Program (SCHIP) and Medicare’s reimbursement to docs (SGR in Beltway-speak).
I am very concerned. I met with staffers for a number of members who are on Ways and Means and from what they said bundling is a done deal. Perhaps the cuts are a way to give dialysis advocates something to fight against allowing bundling to move through the process unchallenged.
The staffers profess to support the non-Large Dialysis Organizations but yet they’re acting to accelerate dialysis provider consolidation. Bundling will accelerate consolidation. Fewer resources will continue the embarrassing US dialysis history of the worst mortality outcomes in the world.
Is it still possible for folks to submit testimony, Bill? If so, how? This would be a great place to explain that.
[QUOTE=Bill Peckham;13992]…the plan is to cut 1 to 1.5 billion from the Part B side of the ESRD program. The money will be taken from the dialysis program to help pay for a fix to the State Children’s Health Insurance Program (SCHIP) and Medicare’s reimbursement to docs (SGR in Beltway-speak).
Fewer resources will continue the embarrassing US dialysis history of the worst mortality outcomes in the world.[/QUOTE]
It’s hard to argue that other programs don’t deserve money either, and it’s become the American Way for people to fight each other for the limited resources that go into the healthcare budget. It obviously always come down to selfish issues. Do we deserve more money than the other? Of course we do! But then again, some of us might have multiple issues and comorbitities. It does get real complicated!
However, the bottom line is he who hollers the most gets the most. ANd this comes back to the number of people who get involved as advocates and rhe methods they use to state their case. Quite frankly, I doubt very much that walking down the aisles of Congress does any good. After all, the other groups that are lobbying for an issue are doing the same thing, and I’m sure our reps in DC are shaking the heads up and down to everybody they meet; once they’re out of the meeting they probably just shrug their shoulders. Nothing ever seems to get done.
Rather than sounding the bugle for retreat, I still believe what’s needed is more proactive action. I’ve written to my congressperson and will continue, but she’s also involved in childrens’ issues, and it seems like it’s always about the children – every election, every time a politician talks – it’s about the children. Well. I’m not against children; after all I once was a child too. But it’s about time adults can honestly stand up and say “what about us older people too?” Perhaps what we need to do is push the envelope a little further when it comes to getting CKD issues higher on the priority list.
The package to fund SCHIP and SGR on the House side is being created behind the scenes. I heard what was being discussed on the House side from a staffer for one of the Ways & Means subcommittee on Health Members. The Senate side finances their SCHIP legislation with tobacco taxes - Medicare Advantage is also coming into play but I’m not sure if it is included on the Senate side, the House side or will be part of the SGR fix.
I see this as at least three different issues.[ol]
[li]Taking money out of ESRD to fund other federal health needs. I think it is short sighted to sacrifice dialyzor health to fund other worthy needs.[/li][li]Decreasing the the over use of EPO. This is based on the JAMA article pointing to higher EPO use among the Large Dialysis Organizations (LDOs) than among the non-profit/Small Dialysis Organizations (SDOs). In addition there is a concern about the safety of EPO. I dispute the safety concerns but the apparent overuse data is from 2004. Since then Medicare has changed the dosing guidelines. In fact there is already data that EPO use is declining in response to the the changes Medicare instituted in November of 2006. In addition Medicare continues to update their guideline for EPO administration, most recently here. Dori if you follow the link you’ll see that there is the opportunity to comment on the EPO monitoring policy until 8/19/07.[/li][li]Expanding the dialysis bundle. I see a disconnect here. On the one hand the staffers I talked to insist that they do not want more dialysis industry consolidation - the implication of this is that they are willing to forgo some of the economic efficiencies gained from consolidation to maintain the diversity of ownership. Yet on the other hand they are moving to expanding the dialysis bundle to include items that are impacted by economies of scale.[/ol]Let me try to explain #3 - it’s the most confusing. The current composite rate is mostly not impacted by economies of scale. Wages, utilities, insurance costs are basically the same for an LDO as for a SDO (supplies are a relatively small part of the current bundle). The expanded bundle would likely include medications and lab tests, which are a very different type of expense and that difference matters. Because LDOs achieve significant savings, economies of scale, on the items in the expanded bundle the bundle rate could not impact various sized organizations equally. The size of the unit does not matter, so much as the size of the unit’s owner. A rural unit owned by a LDO could have a lower operating cost than a suburban unit owned by a SDO.[/li]
I think it is the job of people who care about quality of care, we advocates of improving the provision of dialysis in the US to make sure our Representatives understand the impact of the changes they are considering. I would want every Member of Congress to know that If you’re against consolidation and for non-profit healthcare delivery then understand that position means you are willing to loose some economy of scale (there is a trade off). However, I would point out that you could “have your cake and eat it too” if instead of capturing economies of scale because of provider size, you could instead use CMS’s buying power. After all CMS has the biggest economy of scale potential.
I would then use any savings that resulted from CMS buying items in the expanded bundle to improve the ESRD program. We need to make the program better - healthier and safer.
Thanks, Bill, this is very helpful. How much (if any) role has the Congressional Kidney Caucus played in all of this? Could they be informed and motivated to help on the side of ESRD consumers?
The problem is that we don’t know the details of what they are proposing. And in fact we’re not sure what “problem” they think they’re addressing. Is it dialyzor safety? LDO profits? Medicine maker profits? I felt like as I addressed one area the staffer would change the conversation’s focus to another area; it’s harder to hit a moving target.
I heard that on Wednesday Congressman Stark had the draft bundling proposal from CMS, it would be very helpful to know what CMS is proposing but I think the key is to have the bundling discussion/legislation in the context of improving clinical outcomes not in the context of decreasing the resources available to dialysis providers. It is Congressman Stark who is driving the current apparent approach; it is my impression that the leadership of the Kidney Caucus is going along.
I do think it would be a good idea to inform and motivate members of the Congressional Kidney Caucus to stand up for improved dialysis outcomes. Improved outcomes will require additional resources; cuts to the ESRD program would result in more consolidation and risk worse clinical outcomes and perversely, additional Part A spending. I hear the Congressional Black Caucus (CBO) is standing up against the cuts; they should be encouraged and thanked. I also hear that the Tri-Caucus (CBO, Latino Caucus and Asian/Pacific Islander Caucus) is coalescing around opposition to ESRD program cuts – those Caucus members should be encouraged too.
In general we should ask our members of Congress to ask Chairman Rangel to oppose the cut to ESRD funding. Congressman Stark is committed to changes in ESRD reimbursement but he would need the support of Chairman Rangel to make his preferences law.
[SIZE=3]FYI - here is the article from InsideHealthPolicy.com (registration required; two weeks free)[/SIZE]
Change In Epo Payments, Phased In Bundle Included In House SCHIP Draft Bill, Sources Say
A proposal to set a “statutory rate” for Epogen (Epo) over the short term and bundle payment for the anemia-fighter into the end-stage renal disease (ESRD) composite rate over the long term is part of the House draft proposal to expand the State Children’s Health Insurance Program (SCHIP), revamp the Medicare physician payment system and modify provisions of the Part D low income subsidy, according to physician specialty lobbyists, dialysis interests and Capitol Hill sources.
The priority for Ways & Means health subcommittee Chair Pete Stark (D-CA) is to ensure patient safety and save taxpayer money after wide-spread evidence shows that higher doses of Epo can cause serious cardiovascular problems and death.
This policy continues to draw fire from African-American and other minority members who say it will disproportionately hurt their constituents.
Aides to Stark have refused to comment about the package or whether an Epo-bundling provision is currently in it. A Stark staffer did say that a report promised by outgoing CMS Acting Administrator Leslie Norwalk on CMS’ recommendations on bundling has not been received.
CMS, meanwhile, Friday (July 20) unveiled a policy that will reduce payment for Epo by 50 percent when a beneficiary’s hemoglobin exceeds 13 grams per deciliter for three consecutive months, which doubles the current penalties when hemoglobin levels are exceeded. The new policy, which will go into effect Jan. 1, also requires doctors to lower dosages.
Members of the Congressional Black Caucus (CBC) met last week and continue to worry about the Epo bundling provisions of the House draft package, according to Democratic Hill staffers and lobbyists. The caucus may hold a news conference next week to highlight their concerns, another source close to the caucus tells Inside CMS.
Dialysis patients and independent dialysis center owners met Wednesday with Ways & Means, Energy & Commerce and CBC staffers to plead their case against cuts in payment for the drug or an ESRD bundling policy.
“This is not the time to pull money out of ESRD,” said Diane Wish, president and CEO of the Centers for Dialysis Care, a chain of 14 independent dialysis centers in eastern Ohio. The smaller dialysis centers have a harder time getting discounts for Epo, and what savings they do win goes to pay for losses incurred by treating Medicare patients, losses that can total between $2 and $30 per patient, Wish said.
Wish met with House staffers who she said were sympathetic to her concerns, but wouldn’t tip their hands about what policy Stark is leaning toward.
Various sources suggest that Stark may be considering a policy that shaves reimbursement for Epo, but doesn’t bundle it into the composite rate right away. One proposal being discussed would shave the reimbursement for Epo to average sales price (ASP) plus 3 percent for large dialysis clinics companies, while paying smaller clinics at ASP plus 6 percent, sources say.
Another idea the congressman is eying would move payment to a different “statutory rate” for Epo. Payment for Epo is $9.15, per dose. The proposal would cut payment to $8.15, which dialysis interests suggest would save $3.5 billion over 10 years. Meanwhile, all other drugs used to treat ESRD would be bundled into the composite rate. Additional savings of $3.5 billion over 10 would accrue for every additional dollar Congress shaves from the reimbursement rate, according to dialysis interests.
This policy assumes that Amgen, which manufacturers Epo, would set its price of the drug below the statutory rate. Historically, dialysis interests say, Amgen did this when Congress set a statutory rate for the drug prior to the Medicare Modernization Act.
Dialysis interests, large and small, agree on one thing: Without a set annual update, these types of cuts to payments for drugs will hurt the industry and disproportionately hurt the smaller providers, like Wish’s Centers for Dialysis Care.
The main player in this debate is the CBC, which is afraid that its constituents will be disproportionately hurt by a bundling or statutory rate payment for Epo. DaVita, the dialysis giant, has posted data on its Web site (kidneycareconnections.org) that paint a bleak picture for lawmakers who represent large numbers of minority ESRD patients.
According to DaVita:
- African Americans make up only 13 percent of the U.S. population, but constitute 32 percent of patients treated for kidney failure.
- Eleven percent of new chronic kidney disease (CKD) patients are Hispanic Americans and those with diabetes are “4.5 to 6.6 times more likely to develop CKD than non-Hispanics.”
- Native Americans with diabetes are six times more likely to become ESRD patients compared with all other racial groups.
- Compared to white patients, Asian Americans are twice as likely to develop kidney failure.
Another provision being discussed would mandate, when clinically necessary, subcutaneous (sub “Q”) administration of Epo. Since the June 26 Ways & Means health subcommittee meeting on Epo usage, Fresinius, the German-based dialysis provider, has briefed committee staff about its experience using sub “Q” of Epo, which Stark seemed to favor during the hearing.
An analysis presented to committee staff earlier this month does not indicate the level of savings that Kaiser Permanente officials claim, said a Fresinius official.
Fresinius provided Inside CMS with an analysis of patients treated at 16 dialysis facilities the company owns and contracts with Kaiser Permanente to operate in California.
The company compared intravenous and sub “Q” doses provided at the 16 facilities with those administered at other Fresinius clinics in California.
The mean dosing volume was less in the 16 facilities, but a Fresinius official said that the savings generated was not “statistically significant.” The official said that the dose volume at the 16 facilities was 92 percent of the non-Kaiser facilities that Fresinius owns and operates elsewhere in California, according to a mean-to-mean dosage comparison.
“It certainly doesn’t reach the 30 percent” that Kaiser Permanente officials have alleged, said the official.
Kaiser Permanente, in a letter to the committee, indicated that sub “Q” admin of ESAs, where the drug is injected just below the skin, requires a dose up to 30 percent smaller than IV administration. The managed care giant also bundles Epo payments into dialysis payments and wrote in a letter to Stark that these payments “are consistent with both positive health outcomes for beneficiaries and efficient use of Epogen.”
Permanente physicians at these 16 facilities administer Epo to patients via sub “Q” 85 percent of the time, but when they need to deliver a large dose “those doses, much more disproportionately, tend to be delivered [via] IV,” said the Fresinius official. This is almost the opposite of what goes on in non-Kaiser dialysis clinics owned and operated by Fresinius in California. Ninety-five percent of patients in the non-Kaiser clinics Fresinius studied received their doses of Epo via IV. The five percent of non-Kaiser Fresinius clinic patients received large doses of the drugs via sub “Q”, the Fresinius official said.
Anecdotally, the Fresinius official said nephrologists say that patients don’t like sub “Q” admin because it stings and is uncomfortable.
Doctors usually push a large dose when a patient has an infection, the Fresinius official said, adding that those doses are more often IV-administered because the response time with IV is much quicker.
Wish said that her experience has been that sub “Q” administration irritates patients and is much costlier and time consuming for nurses to administer.
Stark’s office has pointed to Veterans Administration patients, 76 percent of which receive ESAs via sub “Q” administration and savings that range from $2,987 to $4,095 per patient. This administration route results in one-third smaller doses of Epo, Stark said. – Brett Coughlin
There’s not much, we as patients can do about it? Its gonna happen, no matter what?
I don’t know if I impact decisions in DC when I write letters or call my Representatives. I don’t know if I impact decisions in DC when I discuss this online. I don’t know if I impact decisions in DC when I walk the halls of Congressional office buildings. I would like to have an impact but I’m not naive.
I’ve had an interest in legislation since 2000 (the 106th Congress). I’m pretty sure we’d be living in the exact same world if I had never gone to DC and I had never started a single thread about dialysis reimbursement issues. The world would have turned out the same without my involvement. Just as I am pretty sure that there would have been no change in the people who won elections had I never voted in an election since 2000.
Lobbying, like voting, is an act of affirmation. Lobbying is part of the system we live in, just as voting is part of the system - and like voting, if everyone took an interest in lobbying we’d get better results. I can’t think of a reason why others should have a greater interest in dialysis reimbursement than you and me, Gus. It may be that others make these decisions but there is no reason to think they know more about the subject.
I do know one thing. If we do nothing we will have no impact.
EDIT: On reflection I think doing nothing does have an impact. Silence speaks volumes in Washington DC. Dialyzor silence says to our Representatives that we think everything is just fine. We dialyzors don’t have to have the answers but we can let our Representatives know that we think the provision of dialysis needs to be improved. If we say nothing, it says a lot.
Gus, I have to agree with Bill–saying nothing says something: it says that dialyzors don’t care. The only thing that may have some impact on these proposed changes is if legislators do hear from dialyzors–preferably in droves.
Traditionally, in-center hemo patients haven’t gotten very involved in lobbying efforts. DaVita Patient Citizens has done an excellent job of mobilizing its atients by making it easier for them to get involved. But, in general, dialyzors’ voices have been missing from the national dialog.
One of the many reasons that we built this site–with the Legislative Action Center (http://capwiz.com/meiresearch/home/), which is a significant investment each year–is because home dialysis patients have more energy to get involved on their own behalf!. I wish I could keep Congress from taking money out of ESRD and giving it to SCHIP or whatever other programs, but I can’t. You may be able to. Try.
p.s. I’m pretty sure that those Florida voters in 2000 have a very good sense of exactly how much each vote can mean. Everyone counts, and one person can make a difference.
Well, how about taking part in the CNN YouTube Debate? I am not a very political oriented person and think Bill Peckham can politically organize something good. If interested, you might want write up a guidline for those who are willing to participate in the CNN YouTube Debate…many of us are not politically oriented and don’t know what to say and with a polically oriented coordinator I think that will work quite good…
http://www.cnn.com/2007/POLITICS/07/20/debate.preps/index.html
Here’s the main site to send the Youtube videos and ask our politicians about the situation in the ESRD community… http://youtube.com/debates
I think your question points up a fundamental problem Gus. Dialysis is such an odd ball federal program that I’m not sure what dialysis question I’d ask a presidential candidate. This election healthcare reform will have a prominent role but not in terms of dialysis. The move seems to be to make more of healthcare like dialysis which has something approaching universal access. Dialysis hasn’t entered into the conversation.
I think the 35 year US history providing dialysis does have lessons to teach and it’s not good news. Does Congress really want to get into the dosing guidelines for every drug to the degree they’ve gotten into ESA?
As far as bundling - where does it stop? Should all ESRD reimbursement get bundled together? [I]You have ESRD? Here’s your check for $50,000. Spend it wisely it has to last all year.
[/I]What would you ask?
[quote=Bill Peckham;14017]I think your question points up a fundamental problem Gus. Dialysis is such an odd ball federal program that I’m not sure what dialysis question I’d ask a presidential candidate. This election healthcare reform will have a prominent role but not in terms of dialysis. The move seems to be to make more of healthcare like dialysis which has something approaching universal access. Dialysis hasn’t entered into the conversation.
I think the 35 year US history providing dialysis does have lessons to teach and it’s not good news. Does Congress really want to get into the dosing guidelines for every drug to the degree they’ve gotten into ESA?
As far as bundling - where does it stop? Should all ESRD reimbursement get bundled together? [I]You have ESRD? Here’s your check for $50,000. Spend it wisely it has to last all year.
[/I]What would you ask?[/quote]
Then that implies its gonna happen, no matter what! So getting on Youtube for you is not worth it? The exposure is not worth it?
Take a look at all the questions coming in on Youtube, all kinds, all kinds! And home dialysis is not one of them…
[FONT=Garamond]The mark up for the SCHIP legislation is online here(pdf link) HR3162: Children’s Health & Medicare Protection Act of 2007 includes 43 pages of language relating to the ESRD program starting on page 339.
[/FONT] [FONT=Times New Roman][SIZE=3]Scanning through the 43 relevant pages - I think this legislation would be a disaster. Taking money from the program. Extending the private pay period to 42 weeks without an annual update, either one should be a deal breaker. I think it is likely that this Bill will be vetoed but in any case advocates for improved ESRD clinical care should say NO to these provisions.
[/SIZE][/FONT]
[quote=Bill Peckham;14021][FONT=Garamond]The mark up for the SCHIP legislation is online here(pdf link) HR3162: Children’s Health & Medicare Protection Act of 2007 includes 43 pages of language relating to the ESRD program starting on page 339.
[/FONT] [FONT=Times New Roman][SIZE=3]Scanning through the 43 relevant pages - I think this legislation would be a disaster. Taking money from the program. Extending the private pay period to 42 weeks without an annual update, either one should be a deal breaker. I think it is likely that this Bill will be vetoed but in any case advocates for improved ESRD clinical care should say NO to these provisions.
[/SIZE][/FONT][/quote]
Ummm, what I am concerned with is that if this BILL does pass who are the endorsers? Which groups or organiztions are ENDORSING this BILL? Which dialysis clinics are endorsing this BILL? Does your clinic endorse this BILL?
I think this Bill will increase the pressure on the industry to consolidate, so I think those in favor of further industry consolidation will be in favor of this Bill. I am not in favor of additional dialysis industry consolidation, I think my clinic has concerns about the Bill also.
I think home dialysis proponents and more frequent dialysis proponents should also have concerns about this Bill.
Sec. 637 concerns development of ESRD bundling system and quality incentive payments. Beginning January 1, 2010, the Bill would create a bundled payment for dialysis and related drugs and services, with certain requirements to ensure appropriate anemia management. In so doing, total payments would be limited to 96 percent of total estimated payments for all ESRD services if there were no bundled payment system. This means an ESRD program cut of 4% in 20010 while continuing the policy of having no yearly inflation adjustment.
For we advocates of Home Dialysis I think we should be concerned that the bundle includes ESAs, laboratory and diagnostic services, and home dialysis training. Huh?
[quote=Bill Peckham;14023]I think this Bill will increase the pressure on the industry to consolidate, so I think those in favor of further industry consolidation will be in favor of this Bill. I am not in favor of additional dialysis industry consolidation, I think my clinic has concerns about the Bill also.
I think home dialysis proponents and more frequent dialysis proponents should also have concerns about this Bill.
Sec. 637 concerns development of ESRD bundling system and quality incentive payments. Beginning January 1, 2010, the Bill would create a bundled payment for dialysis and related drugs and services, with certain requirements to ensure appropriate anemia management. In so doing, total payments would be limited to 96 percent of total estimated payments for all ESRD services if there were no bundled payment system. This means an ESRD program cut of 4% in 20010 while continuing the policy of having no yearly inflation adjustment.
For we advocates of Home Dialysis I think we should be concerned that the bundle includes ESAs, laboratory and diagnostic services, and home dialysis training. Huh?[/quote]
Something don’t sound right, will do some insider research on this and will get back to this post…I think there may be some mis-intepretation regarding the real issue.
Wow Gus do you belong to an “insider” listserv too? You seem to be under the impression that people are working in your interests - that’s one point of view.