HR 3096 is introduced with 18 cosponsors

Discussions for Patients, Family, and Friends HD For Patients
1

The Kidney Patient More Frequent Dialysis Quality Act of 2005 has been introduced into the House of Representitives. In part it reads:

…Not later than 1 year after the date of enactment of this paragraph, the Secretary shall develop, in consultation with the renal community, a standard of care and quality standards for more frequent hemodialysis. The Secretary shall periodically review and update as necessary such standards…

To read the entire Bill go to http://thomas.loc.gov/ and enter the number 3096 in the search box. Now we need a companion Bill for the Senate.

2

This is a much needed piece of legislation. Contact you Represenative if he or she is not yet a sponsor.

3

I’ve already did my part in contacting them and hope they LISTEN

4

Thanks Gus and Jfwag, I think those of us who have the option of doing more frequent dialysis should let our Representatives know how much better it makes us or our loved one feel. I know that sometimes it feels like no one is listening or it doesn’t matter but we need to keep telling anyone who will listen that people with kidney failure should have the chance to choose more frequent hemodialysis. Those of us with the option to dialyze more frequently need to share our experiences so that more people have our healthier dialysis options. Our dialysis options should not depend on our zip codes.

5

Just checking…this is the old HR 1004, correct? Or some facsimile? I need to update a chapter in my book and I want to be sure. Thanks, John

6

Hi y’all,

We’ve now included this bill in the Legislative Action Center part of our site.

7

Yup. New Congress; new Bill numbers. This version does differ from 1004 in the 108th Congress in that it specifies more frequent dialysis as 4 or 5 treatments a week. The hope is that this will get the Bill “scored” lower by the Congressional Budget Office. The CBO reckons the 10 year cost of a Bill - its “score” and in the current political environment it is important to have a low score.

8

Bill P. or anyone, I was recently asked if this legislation would cover in-center TXs also? I wasn’t able to tell by looking at it, but I didn’t see where it might specify only home hemodialysis. Any insight into this?

9

John, this legislation does not differentiate between incenter and home hemo. I think the reason people generally think of home hemo when talking about more frequent dialysis is because of the logistical barriers to offering more frequent dialysis incenter. I think HR 3096 would allow some progressive providers a bit of room to try different ideas. For instance staying open 7 days a week and offering people the option of every other day dialysis. Or offering a forth treatments to anyone who would take it on the day they normally would be closed.

In my opinion the ideal would be a situation where a unit’s patient population could dialyze as often as they wanted. There’d be people running 3 (or even 2) times a week right next to folks running 6 times a week. One could dialyze based on one’s needs not based on scheduling convenience. This Bill will not make that happen but I think it will allow some creative options that are not financially practical today.

10

This I completely agree with. Let us just hope that there will be units willinng to explore this. The person will be happy to know this.

11

Diagnosed 1967 “A Nephrotic Syndrome”
Ho Ho!
Brescia shunt 1973
February 1973 Native kidney nephrectomies spleenectomy

February 1974 - July 1974 In-center Hemodialysis
July 1974 Cadaver Transplant
July I CAN"T REMEMBER ALL THIS!

12

Hi y’all,

I wanted to share a message from Dr. Chris Blagg about the bill:

Dear patients, relatives of patients, friends, physicians, nurses and others

On June 28th Jim McDermott (D) and Melissa Hart ® and 17 co-sponsors introduced HR 3096, the Kidney Patient More Frequent Dialysis Quality Act of 2005. This now has 26 co-sponsors. The bill requires the Secretary of Health to develop payment rates for more frequent hemodialysis (daily or nightly) done at home or in a facility and for patient training for more frequent hemodialysis.

Now, while Congress is in the summer recess, is a good time for all of you who are interested in encouraging more home and more frequent hemodialysis to call to speak to your Representative or their Health Aide, both in their local and their Washington offices, and also to invite them to your dialysis unit. Urge them to support this bill by co-sponsoring it or if they have already done so (see attachment) thank them. Alo urge their support for other ESRD-related legislation. Follow up with an email or fax. You might do the same with other Representatives from your state. Although there is no Senate version of the bill yet, educate your senators about the importance of home and more frequent hemodialysis too. Please ask your family members and friends who live in your state or other states to do the same. Do not send a letter by regular mail as this may take time to get through because of security.

Patients in particular should stress the numerous benefits of more frequent dialysis in their own words. One attachment to this email is a summary of its advantages These include many fewer symptoms during and between dialyses, much better quality of life, and greater opportunity for rehabilitation, fewer days in hospital, the need for less of the expensive drug, EPO and the reduction or elimination of the need for drugs to treat high blood pressure. Any personal experiences you can describe would be wonderful.

Point out that the extra costs of doing more frequent dialysis are more than offset by the considerable cost savings from fewer days in hospital and less EPO use. The number of dialysis patient is expected to double in the next 10 years, meaning a lot of new dialysis units will be needed and the nursing shortage will not go away. Home dialysis, and particularly more frequent dialysis, is less costly and better treatment than conventional center dialysis for suitable patients. Above all, emphasize the many improvements in patient wellbeing. The many reports from here and other countries all say the same good things about this treatment.

If legislators or their staff have questions they can contact Rep. McDermott’s office (206-225-3106) or Rep. Hart’s office (202-225-2565).

Please let us know who you have contacted and their response. Timing is critical. We need as many co-sponsors of HR 3096 as we can get.

Here is the list of sponsors to date:

Rep Bordallo, Madeleine Z. [GU] - 6/28/2005

Rep Brady, Robert A. [PA-1] - 6/28/2005

Rep Capuano, Michael E. [MA-8] - 7/28/2005

Rep Christensen, Donna M. [VI] - 7/14/2005

Rep Cummings, Elijah E. [MD-7] - 7/14/2005

Rep Dicks, Norman D. [WA-6] - 6/28/2005

Rep Goode, Virgil H., Jr. [VA-5] - 7/14/2005

Rep Goodlatte, Bob [VA-6] - 6/28/2005

Rep Hart, Melissa A. [PA-4] - 6/28/2005

Rep Hastings, Doc [WA-4] - 6/28/2005

Rep Higgins, Brian [NY-27] - 7/14/2005

Rep Hinchey, Maurice D. [NY-22] - 7/28/2005

Rep Inslee, Jay [WA-1] - 6/28/2005

Rep Israel, Steve [NY-2] - 7/28/2005

Rep Jackson-Lee, Sheila [TX-18] - 6/28/2005

Rep Kildee, Dale E. [MI-5] - 6/28/2005

Rep Kirk, Mark Steven [IL-10] - 6/28/2005

Rep Lewis, John [GA-5] - 6/28/2005

Rep Lofgren, Zoe [CA-16] - 7/28/2005

Rep McNulty, Michael R. [NY-21] - 6/28/2005

Rep Moran, James P. [VA-8] - 6/30/2005

Rep Owens, Major R. [NY-11] - 6/28/2005

Rep Rangel, Charles B. [NY-15] - 6/28/2005

Rep Sanders, Bernard [VT] - 6/28/2005

Rep Schiff, Adam B. [CA-29] - 6/28/2005

Rep Smith, Adam [WA-9] - 6/28/2005

Rep Wexler, Robert [FL-19] - 6/28/2005

13

I was just about to post the same email from Dr. Blagg that I recieved. Dori beat me to it.
I am awaiting a call from Rep. James McGovern, D/MA myself. Here is some more from Dr. Blagg and Lockridge:
Talking points if you will: (we all know this but simplification sometimes helps)

ADVANTAGES OF MORE FREQUENT HEMODIALYSIS

Many fewer symptoms during dialysis – hypotensive crashes, cramps and other symptoms are all greatly reduced in severity and frequency

Reduction or elimination of post-dialysis fatigue and other symptoms between treatments

Improved appetite and better nutrition

Increased energy

Better overall well-being

Better quality of life

More opportunity for rehabilitation

Improved sexual function

Elimination of sleep problems

Better control of hypertension with less or no drugs

Better control of anemia with less erythropoietin

As good or better survival of blood access

Fewer hospitalizations and fewer hospital days

Better patient survival

(References are available on request from:
Christopher R Blagg MD, 206-234-8791, blaggc@hotmail.com
Robert S Lockridge MD, 434-660-7417, rlockridge@lynchburgnephrology.com)
●
Key Elements of HR 3096:
□ Establishment of a payment rate for more frequent hemodialysis (and
equivalent treatments requiring blood access), independent of location and that
takes into account the cost of more frequent dialysis, the great benefits to patient
wellbeing and the reduced total costs of treatment. Rates will be defined for:
ongoing more frequent dialysis at home or in-center
□ Identical reimbursement rates for Method I and Method II billing.
□ Empowerment of the Secretary of CMS to define standards of care and quality
standards for more frequent dialysis in consultation with the nephrology community.
□ Clinical judgment of the physician caring for the individual patient to decide
who is a “qualified individual”
□ More frequent hemodialysis is defined as hemodialysis sessions or equivalent
therapy requiring blood access performed 4 or 5 times per week.

(Might be redundant)

John Francis Wissler

14

Been trying and trying, already sent messages to my legislator of my area…hope they listen…

15

Hi y’all,

Drs. Chris Blagg & Bob Lockridge sent out this email today about the Kidney Patient More Frequent Dialysis Quality Act of 2005:

Dear patients, relatives of patients, friends, physicians, nurses and
others,

On June 28th Jim McDermott (D) and Melissa Hart ® and 17 co-sponsors introduced HR 3096, the Kidney Patient More Frequent Dialysis Quality Act of 2005. This now has 31 co-sponsors. The bill requires the Secretary of Health to develop payment rates for more frequent hemodialysis (daily or nightly) done at home or in a facility and for patient training for more frequent hemodialysis.

Now is a good time for all of you who are interested in encouraging more home and more frequent hemodialysis to call to speak to your
Representative or their Health Aide, both in their local and their
Washington offices, and also to invite them to your dialysis unit. Urge
them to support this bill by co-sponsoring it or if they have already done so thank them. Also urge their support for other ESRD-related legislation. Follow up with an email or fax. You might do the same with other Representatives from your state.

Although there is no Senate version of the bill yet, educate your senators about the importance of home and more frequent hemodialysis too. Please ask your family members and friends who live in your state or other states to do the same. Do not send a letter by regular mail as this may take time to get through because of security. NOTE: You can send an email letter to your Congressperson or Senator through Home Dialysis Central, at http://capwiz.com/meiresearch/mail/oneclick_compose/?alertid=7790756.

Patients in particular should stress the numerous benefits of more
frequent dialysis in their own words. Below is a summary of its advantages. These include:
– Many fewer symptoms during and between dialyses
– Much better quality of life
– Geater opportunity for rehabilitation
– Fewer days in hospital
– The need for less of the expensive drug, EPO
– Reduction or elimination of the need for drugs to treat high blood pressure.
Any personal experiences you can describe would be wonderful.

Point out that the extra costs of doing more frequent dialysis are more
than offset by the considerable cost savings from fewer days in hospital and less EPO use. The number of dialysis patient is expected to double in the next 10 years, meaning a lot of new dialysis units will be needed and the nursing shortage will not go away. Home dialysis, and particularly more frequent dialysis, is less costly and better treatment than conventional center dialysis for suitable patients. Above all, emphasize the many improvements in patient wellbeing. The many reports from here and other countries all say the same good things about this treatment.

If legislators or their staff have questions they can contact Rep.
McDermott’s office (206-225-3106) or Rep. Hart’s office
(202-225-2565).

Please let us know who you have contacted and their response. Timing is critical. We need as many co-sponsors of HR 3096 as we can get. If you would like more detailed information feel free to
contact us. Chris and I will be in Washington the first week in October.

Thank you,

Christopher R. Blagg MD Robert S. Lockridge MD
blaggc@hotmail.com rlockridge@lynchburgnephrology.com

ADVANTAGES OF MORE FREQUENT HEMODIALYSIS

– Many fewer symptoms during dialysis – hypotensive crashes, cramps and other symptoms are all greatly reduced in severity and frequency

– Reduction or elimination of post-dialysis fatigue and other symptoms between treatments

– Improved appetite and better nutrition

– Increased energy

– Better overall well-being

– Better quality of life

– More opportunity for rehabilitation

– Improved sexual function

– Elimination of sleep problems

– Better control of hypertension with less or no drugs

– Better control of anemia with less erythropoietin

– As good or better survival of blood access

– Fewer hospitalizations and fewer hospital days

– Better patient survival

(References are available on request from:
Christopher R Blagg MD, 206-234-8791, blaggc@hotmail.com
Robert S Lockridge MD, 434-660-7417, rlockridge@lynchburgnephrology.com)

H.R.3096
Title: To amend title XVIII of the Social Security Act to provide for payment under the Medicare Program for more frequent hemodialysis treatments.
Sponsor: Rep McDermott, Jim [WA-7] (introduced 6/28/2005) Cosponsors (27)
Latest Major Action: 7/1/2005 Referred to House subcommittee. Status: Referred to the Subcommittee on Health.

Rep Bordallo, Madeleine Z. [GU] - 6/28/2005
Rep Brady, Robert A. [PA-1] - 6/28/2005
Rep Capuano, Michael E. [MA-8] - 7/28/2005
Rep Christensen, Donna M. [VI] - 7/14/2005
Rep Cummings, Elijah E. [MD-7] - 7/14/2005
Rep Dicks, Norman D. [WA-6] - 6/28/2005
Rep Goode, Virgil H., Jr. [VA-5] - 7/14/2005
Rep Goodlatte, Bob [VA-6] - 6/28/2005
Rep Hart, Melissa A. [PA-4] - 6/28/2005
Rep Hastings, Doc [WA-4] - 6/28/2005
Rep Higgins, Brian [NY-27] - 7/14/2005
Rep Hinchey, Maurice D. [NY-22] - 7/28/2005
Rep Inslee, Jay [WA-1] - 6/28/2005
Rep Israel, Steve [NY-2] - 7/28/2005
Rep Jackson-Lee, Sheila [TX-18] - 6/28/2005
Rep Kildee, Dale E. [MI-5] - 6/28/2005
Rep Kirk, Mark Steven [IL-10] - 6/28/2005
Rep Lewis, John [GA-5] - 6/28/2005
Rep Lofgren, Zoe [CA-16] - 7/28/2005
Rep McNulty, Michael R. [NY-21] - 6/28/2005
Rep Moran, James P. [VA-8] - 6/30/2005
Rep Owens, Major R. [NY-11] - 6/28/2005
Rep Rangel, Charles B. [NY-15] - 6/28/2005
Rep Sanders, Bernard [VT] - 6/28/2005
Rep Smith, Adam [WA-9] - 6/28/2005
Rep Schiff, Adam B. [CA-29] - 6/28/2005
Rep Wexler, Robert [FL-19] - 6/28/2005

CURRENT MEDICARE REIMBURSEMENT POLICY LIMITS ADOPTION OF MORE FREQUENT HEMODIALYSIS AND RELATED TREATMENTS

  • Current reimbursement limits hemodialysis generally to three times a week. This precludes patients from enjoying the great benefits of more frequent dialysis.

  • Current reimbursement creates a financial disincentive for facilities to adopt daily or nightly dialysis, even though their patient benefits are well established.

  • Although direct reimbursement to dialysis facilities must be increased to allow greater access to more frequent dialysis, overall costs to Medicare would be reduced because of fewer hospitalizations and reductions in the use of drugs.

  • In 2003, Medicare spending on hospitalization was up by 10%. More frequent dialysis is one way this can be reduced for ESRD patients.

  • The CMS/NIH study currently about to start will take until 2009 to produce results.

LEGISLATIVE SOLUTION

  • The Kidney Patient More Frequent Dialysis Quality Act of 2005: Congressman Jim McDermott (Dem., Washington) and Congresswoman Melissa Hart (Rep, Pennsylvania) introduced H.R. 3096 on June 28, 2005 with 18 (now 26) cosponsors.

  • Key Elements of HR 3096:
    – Establishment of a payment rate for more frequent hemodialysis (and equivalent treatments requiring blood access), independent of location and that takes into account the cost of more frequent dialysis, the great benefits to patient wellbeing and the reduced total costs of treatment. Rates will be defined for: ongoing more frequent dialysis at home or in-center

– Identical reimbursement rates for Method I and Method II billing.

– Empowerment of the Secretary of CMS to define standards of care and quality standards for more frequent dialysis in consultation with the nephrology community.

– Clinical judgment of the physician caring for the individual patient to decide who is a “qualified individual”

– More frequent hemodialysis is defined as hemodialysis sessions or equivalent therapy requiring blood access performed 4 or 5 times per week.

ENDORSEMENTS
Similar legislation has been supported in the past by the National Kidney Foundation, the American Nephrology Nurses Association and the Renal Physicians Association and the American Association of Kidney Patients has encouraged “development of new treatment methods which will result in improved quality of care and clinical outcomes for kidney patients.” All reports from the U.S. and elsewhere have shown that both more frequent short dialysis by day and long overnight dialysis are significantly better for patients than conventional three times a week dialysis. As a result the governments of the Netherlands, the Province of British Columbia, Canada and the State of Victoria, Australia all support more frequent dialysis. The best argument for more frequent dialysis is the glowing testimonials from patients who have experienced more frequent dialysis and its many benefits despite the extra work required. Very few of them want to go back to thrice weekly treatment.

This treatment should be an option available to all suitable ESRD patients.

Christopher R Blagg MD, 206-234-8791, blaggc@hotmail.com
Robert S Lockridge MD, 434-660-7417, rlockridge@lynchburgnephrology.com

16

Good news, I just recieved confirmation of meeting next week with my Rep. James McGovern (D-MA).

17

We now have Rep. James McGovern (D-MA) on our side.

18

Wow! That meeting must have gone well. Any tips you can share with others who are calling, writing or visiting their legislators to support this legislation? What in your presentation appealed most to the legislator (or his staff)? What did you find 1) the most interesting and 2) the most challenging about your meeting with your legislator? Congratulations!

19

I sent my MD representative an email!
I recently had to go in-center for four months…I DO NOT want to go back to three times a week treatments. :slight_smile: We NEED payments for more than 4 treatments a week!

20

Hi everyone,

The meeting went very well.

Tips:

  1. Go in and know what you are talking about. (Be prepared) Dr. Blagg and Dr. Lockridge can send you background information and charts. (also on this thread)
  2. My presentation was being able to give out aforementioned information, and I had something on my side as in having a book I have written dealing with a personal story and home dialysis. That didn’t hurt.
  3. I would say that mentioning 4-5 days vs. original 6-7 “CBO scoring” budget constraints (Thanks Bill P. for that little bit of politics, seriously) is always going to be popular with officials that want to save money. That will get the attention of your representative. Although this bill hasn’t been scored Mr. McGovern wanted to know if it had been. (Answer what you know)
  4. The most challenging aspect was my own self doubt and getting over it. But what I found out, and I talked with Dr. Blagg minutes out of the meeting, was that if you know what you are talking about and have the experience then don’t worry. “You have experience,” were his words.
  5. They want to know how to save money. I told Mr. McGovern, among many other things, that HR 3096 will in the long run save the taxpayers money. We all know that. (Give them your experience) He was telling me about a friend of his etc…75 years old getting sick every other day. I told him this bill could change this.
  6. Remember that home dialysis has history on its side. Early on, in the sixties, that is what was done. Give your congressperson some ESRD history. The advantages are not unknown; and say that we really don’t want to wait around until 2009 for the NIH study. This bill, HR3096, has had many incarnations. It sits in the Ways and Means Committee, and on and off for years never comes to the floor. Mr. McGovern told me he would see what he can do to get it out of committee and will speak with Rep. McDermott this week. This is one step. Congress is a “chore” that takes kissing … (make up your own words here) There are many, many bills that go nowhere.
  7. Stress this. In 1973 Medicare/ESRD slowly was turned over to for-profit companies. That is still where we are today too much of the ESRD community, but we are trying to educate all nephrologists and the government.
  8. Tell your congressman the advantages, medically. I spent a good portion of my meeting discussing what I observed with Lois. (labs, overall cost and lack of going to an emergency room over and over again.)
  9. Dropping names such as Dori Schatell, Dr. Chris Blagg, Dr. Robert Lockridge, Dr. John Agar (Australia) believe me, doesn’t hurt.
  10. Lastly, know the history of your congressperson whether a democrat or republican, and ask “why are you not sponsoring this bill?” A quick joke about the opposing … can’t hurt
  11. This is, in general how I went about it. I wish everyone luck.