I guess I didn’t read closely enough. Ed Jones of Kidney Care Partners said this last year. It would be nice to have some clarification to other groups whose health plans don’t have to pay first.
I just found a new argument in support of keeping employer plans primary for an additional 12 months in the current online version of Nephrology News & Issues (see Extending the MSP)
[I]The Kidney Care Partners writes in defense of extending Medicare’s Secondary Payer status
By Edward R. Jones, MD, Chairman, Kidney Care Partners
As the chairman of Kidney Care Partners—a coalition of dialysis patients, professionals, care providers and manufacturers dedicated to working together to improve quality of care for individuals with kidney disease – and an advocate for the entire kidney community, I feel it is important to set the record straight with regard to extending the Medicare Secondary Payer (MSP) provision by 12 months.
The Medicare End Stage Renal Disease program is a 35-year-old program that serves over 400,000 Americans living with irreversible kidney failure – and one that I would add has not kept pace with patient and provider needs.
Extending Medicare’s secondary payer status for ESRD patients from 30 to 42 months is sound policy.
This 12-month extension will generate savings to the Medicare program which can then be used to educate people who have kidney disease and ensure their continued access to high quality care. And an additional year of responsibility for beneficiaries would only encourage private payers to adopt protocols that address patient wellness, prevent hospitalizations, and make dialysis safer and more efficient.
Kidney failure is, in fact, the only disease condition where private insurers can deny coverage. Even if patients want to remain in their private health insurance plan, they are required after 30 months of coverage to go onto Medicare. On the other hand, ESRD patients are eligible to drop private coverage and enroll in Medicare at any point after the third month of treatment, however many patients prefer their private coverage and would like the option to remain in private coverage beyond 30 months. As a result of the policy, kidney patients face coverage disruption, higher out-of-pocket costs, loss of integrated family coverage, and greater complexity. Dialysis patients should be afforded the same rights as others to choose how their care is financed.
And while improving quality of care and access for kidney failure patients, the MSP extension would have a negligible cost impact for private employers. It is estimated that between 5,000 and 10,0000 of the nearly 400,000 ESRD beneficiaries would remain privately insured from month 31 to month 42 if MSP were extended – and would be spread across hundreds of insurance plans. According to the most recent census data, approximately 200 million people are covered by private health insurance in the United States. Therefore, a 12-month extension of MSP would result in a 0.005-percent increase in the total population of privately-insured Americans. It is clear that the policy would have an insignificant impact, if any at all, on health insurance costs to employers.
Kidney patient advocacy organizations endorse the MSP extension as being in the best interest of patients, the Medicare program, taxpayers and the renal community. They say the MSP extension assures access and quality of life-sustaining care required by kidney patients:
The Renal Support Network, a patient organization of thousands of people with kidney disease, issued a letter to Senator Debbie Stabenow and the entire Senate Finance committee:
RSN supports the MSP Extension, citing its potential positive benefits to patients. These include extending patient choice and accessing the best quality of care possible, selecting the most comprehensive coverage and having the lowest out-of-pocket costs. It can also allow patients to maintain dependent family coverage and offer some patients access to disease management services that may improve outcomes and reduce overall costs.
In a letter sent to the Senate Finance Committee, the National Kidney Foundation (NKF) writes (click here to download a PDF of this letter):
“H.R. 3162, the Children’s Health and Medicare Protection Act (CHAMP), as passed by the House, contained enhanced benefits for kidney patients. NKF understands the need for an offset in the current Pay-Go environment. Therefore, we reiterate NKF’s longstanding decision to support extension of Medicare Secondary Payer, to 42 months, as proposed by the House, provided that the savings are dedicated to improvements to the Medicare ESRD program.”
The American Kidney Fund writes in a letter to the Senate Finance Committee (click here to download a PDF of this letter):
“We understand the difficult budgetary challenges you and your colleagues face and recognize that new spending must be offset by cuts in other areas. We support an additional 12 month extension of Medicare secondary payer (MSP) as a means to generate savings to help offset the costs of other improvements for patients in the ESRD program.”
An excerpt of a letter from DaVita Patient Citizens, one of the largest dialysis patient organization with over 20,000 members—pre-dialysis and dialysis patients as well as their family members—reads (click here to download a PDF of this letter):
“Besides restricting patients’ right to choose to keep their private insurance coverage longer, not extending the MSP period will prevent many of the needed reforms within the ESRD program. One of the most important steps is to provide those individuals at risk of kidney failure with education about the factors associated with kidney disease in the hopes of preventing them from reaching kidney failure. Consistently our members state that they were not aware of the risk factors that cause much of kidney disease—diabetes and hypertension. Prior knowledge could have reduced their risk of kidney failure and possibly dialysis, and the savings that MSP extension would achieve will help fund much-needed education and prevention programs.”
In a pay-as-you-go environment, a modest extension of MSP raises necessary revenues for critical reforms within the program. It is only designed to generate modest savings in Medicare to offset the cost of implementing key improvements to the program, such as coverage of educational sessions for pre-ESRD beneficiaries and quality payments, while also providing choice to patients.
The kidney community strongly supports reform in the ESRD program, which includes reforming the current MSP provision. Early identification, prevention and disease management are good for Medicare, taxpayers and patients who depend on quality kidney care.
*The KCP recently held an educational briefing about the Medicare ESRD program. To view the agenda, click here.
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