I also remember Pat! Marty talked to her and had her contact me telling me if I couldn’t get into a program in Jersey I could come up there for training. Thanks both of you!
Bill I count five reps. from Jersey, no one names that I recognize! Hmmmm! Lin.
Okay, that works…
Cheers! 
HR 1298 is up to 159
Rep Bartlett, Roscoe G. [MD-6] - 6/15/2006
Rep Mack, Connie [FL-14] - 6/19/2006
Rep Burgess, Michael C. [TX-26] - 6/21/2006
Rep DeFazio, Peter A. [OR-4] - 6/22/2006
Rep McHenry, Patrick T. [NC-10] - 6/22/2006
have all signed on and on the 635 Senate side Senator Boxer in California signed on … Gus did you write Boxer? Now you need to go after Feinstien.
Wow, support is growing! 
Yes I did Bill, I sent messages to both Senators and my local congressman. Looks like Boxer responded first, still waiting for the others to respond…
Among the provisions of the bill are initiatives that would:
– Expand patient education for patients at risk for kidney disease, those with chronic kidney disease, and those in kidney failure to help them better manage their disease;
– Create a quality outcomes-based pilot project; and
– Ensure quality by creating an annual update framework that will allow kidney care providers to keep pace with medical and technological advances that will lead to improved care outcomes.
Can someone give more specifics on the proposed provisions?
I’ve attached the text of H.R. 1298. The Senate bill is the same.
I read through the bill, but much of it is greek to me. Let’s just take the education part for those on dialysis. What specifically does the bill say will improve in terms of education for those on dialysis? For education of patients to improve, education/training of staff has to improve. I see where the bill calls for certification of techs. It seemed to say current staff who have worked in dialysis for x amount of yrs. will be grandfathered in, while those of short duration in dialysis must get certified. Is that what it said?
Again, it is not an increase. An update framework restores existing value. I just do not understand. If you think things are suboptimal now, why do you think less money would be a step in the right direction?
Jane it sounds like you’d be in favor of the KCP’s Kidney Care Quality Initiative:
http://www.kidneycarepartners.org/quality/index.html
This new legislation would link reimbursement to performance.
“The Kidney Care Quality Initiative (KCQI) seeks to encourage high-quality care for patients with kidney disease and kidney failure by developing payment reforms that directly link reimbursement to the quality of care provided in the Medicare End Stage Renal Disease (ESRD) program.”
I think we should start a new thread if you would like to discuss this idea for legislation. I just wanted to make the point that there will be new legislation. There will always be new legislation.
Back to 1298. When you read these Bills, it may seem like gobbly-gook but each word has an impact. 1298 calls for four CKD4 classes, is that enough? Should the content of the classes be spelled out to include self-advocacy? Or an explanation of grievance procedures? Maybe. But at least with 1298 you’ll have a platform, an additional tool that will now be available to address problems you see.
Same with Tech certification – if it is written into law then you’ll have another path to improving in unit care. You could advocate in future years to strengthen Tech certification – we should not expect perfection right out of the box, an incremental approach is the only approach available.
Imagine if this Bill had been passed 2 years ago. We would be discussing rule changes to what should be taught in pre-dialysis classes and maybe periodic recertification of techs – just like drivers licenses. I don’t know … but wouldn’t that be a pleasant thing to advocate for? The point is that right now there is nothing to build on, 1298 gives us something to build on.
Hi y’all,
Jane wrote:
Let’s just take the education part for those on dialysis. What specifically does the bill say will improve in terms of education for those on dialysis?
I was frustrated by the lack of specificity in the language, too–but that’s how laws are written, apparently. (This is not something I know a whole lot about, so I’ve been learning along with the KCP process). The law is the broad brush outline, and then when a law is passed, there are interpretive guidelines or regulations that will spell out the details. So, step one is to get the law passed, and step two would be to try to provide input on the interpretive process to ensure that it does what the law intended.
Bill,
Taking you up on your suggestion to check out KCP’s Kidney Quality Iniative, I read the section of meeting notes on Quality of Life/Patient Perspectives. Dear Lord Bill, what language do you folks speak in these meetings? Again, it was all greek to me and I did not even hear a mention of the main issues that I am concerned about. How would the average dialysis patient even relate to such a meeting?
I hear what you are saying about getting laws on the books in order to more finely address the real problems. Have there been no laws to this point to do so? As I have said before, the companies, networks and state regulators have all kinds of regulations on their books for patient care- the problem is, they are not enforced strictly.
This new bill seems like a smokescreen to me. It seems to say, the reason we have so many problems in dialysis is because companies do not get paid enough. I quess that is the fundamental difference of opinion between us- I do not feel that dirty units, staff not washing their hands and other related issues of care has anything whatsoever to do with the amount of payment- I feel it is an enforcement issue.
I am not in anyway saying that I do not believe units should be paid appropriately with annual increases. But I am saying that we have a very fowl problem in the dialysis industry of a serious breech in patient care.
Most definitely, let’s start a new thread (or a separate board within this site), because I think it is so essential that we keep this issue in the public eye. If the powers that be don’t respect this site, I don’t know what site they would respect. Dori and Beth have done an exemplary job of managing HDC, a site dedicated to bringing out what educated patients desire for safe, optimal dialysis care.
The basic tenants of dialysis care have been ignored by the dialysis industry. As educated patients, we must continue to talk the subject up amongst ourselves and strive to find the solutions to the enforcement problem.
Just an update, I finally recieved from snail mail a letter from my Congressman from my district and stated he will take into account on legislation concerning H.R. 1298 … at the bottom of the letter in tiny letters it states that he preffers messages sent through his website and that mailed messages can take up to 8 weeks fro a response!!
It’s my understanding that mail to Congress goes to one postal center where it is irradiated before being delivered to your senator or representative. This is why it takes a much longer time for your letter to reach your elected official as compared to an email or fax.
The above link is to a recent editorial in the Seattle PI newspaper from their editorial board in support of 1298/635. This is the first step in a NKC effort to generate media support for the Kidney Care Quality and Improvement Act.
1298 is up to 165 cosponsors; 635 is still at 33. Now would be a very good time to make another push if your representatives are not yet signed up. I’m hearing that when Congress goes back to work next month one item they have to address is Medicare physician reimbursement. The way things work in DC is that once they start working on an issue, related issues can be added to the legislation. Once they introduce a Bill having to do with Medicare other Medicare related issues can be included in the legislation.
I would not expect the Kidney Care Quality and Improvement Act to be passed as a stand alone piece of legislation but elements of the Kidney Care Quality and Improvement Act could be incorporated into a Bill adjusting physician reimbursement. This is more likely to happen with each additional cosponsor.
Just reminder that congress gets together soon this voting season and now is the time to get write to your legislators.
Also wanted to let you all know that “Davita Citizens” will hand deliver our letters to our legislators to Washington D.C. …so if your not a member of “Davita Citizens” you might want to consider it. This patients organiztion is quite strong and has different levels of participation. Find out more about them at… http://dialysispatients.org/
JOIN DAVITA CITIZENS
http://dialysispatients.org/membership.cfm
After becoming a member you will recieve a kit of your membership and also you will recieve important notices regarding legislation. Please take part in this, we really need more funding for our dialysis community. More funding means better health outcomes and a better future.
If you’d prefer to send your letter through Home Dialysis Central, visit our Legislative Action Center. We have a template letter you can choose to use or modify as you see fit. The bill is both in the House (HR 1298) and the Senate (S 635) and the links to the template letters for each is on the main Legislative Action Center page:
http://capwiz.com/meiresearch/home/
If you don’t know who your senator (S 635) or representative (HR 1298) is, if you enter your zip code your letter will be sent to the correct person.
HR 1298 still has momentum - three new cosponsors signed on to the Bill on September 6th so the total is up to 168 (and I hear another three are in the wings). When this process started I remember thinking that if we could get 170 something cosponsors in the House the Bill would have a chance - we’re nearly there. On the Senate side I was thinking the target should be 40 something comsponsors, right now we’re stuck at 33.
Now would be the time to reach out to your Senator if they have yet to sign on, and any Republican members of the House.
The other tactic would be to approach your local paper’s editorial board. All Congressional Representatives keep track of editorials in the home town paper. If you can get the paper to take a postion on these Bills it can raise the issue’s visability.
Forgot to mention before, from the Legislative Action Center you can also send a letter to the editor of any or all of the newspapers in your area. It really helps to personalize these types of things…
– If you didn’t have CKD education, you might say you would have liked to have had education prior to developing kidney failure but there is no funding for education that could have helped prolong your kidney function
– Since you’re doing home hemodialysis (or caring for someone who is), tell people that you (or your loved one) can get more treatments but most people can’t because Medicare doesn’t pay for more than 3 treatments a week
– Everyone is concerned about quality of care. Medicare reimbursement should be updated annually for dialysis clinics just like it is for other providers. Medicare’s low reimbursement means that employer health plans are paying more than their share. This means that private companies have to pay paying higher. Their higher premiums either mean employees pay a larger share, coverage is reduced, or sometimes employees with kidney failure or with dependents with kidney failure have lost their jobs.
http://www.heraldnet.com/stories/06/09/11/100loc_b1kidney001.cfm
The above link is to a pro 1298/635 article. If your Senators or Representative hasn’t signed on yet then going to your local papers is one way to raise this issue’s visability. My understanding is that papers like to see informaiton in print before acting so forwarding the links to the editorial and the article to the local paper’s health reporter may be enough to get them to write something by adding the local slant.
According to this 8/8/06 news release CMS (Medicare/Medicaid) has recommended:
Updating the wage index and drug add-on adjustments applied to the composite payment rate for dialysis services provided by ESRD facilities. The total drug add-on adjustment to the composite rate for CY 2007, including the growth update adjustment of 0.6 percent, would be 15.2%.
Hopefully this will help.
http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1939
Hi Folks
Nice Film Bill, by the way, I heard your Q&A talk on the other page also.
I not sure if this is on subect or not, But would more companies or places that offer dialysis be a way of getting more $?
The way I look at it dialysis pts. make a small part of the medical world when you look at cancer etc. It not that dialysis isn’t of importance but the dialysis world as a whole ( center, pts ,etc) I think add up up what#. I think I’ve seen 500,000.00 pts. across the USA? Where is that in the rank of medical problems?
I do write to my people in PA and want better for all but we need more grassroot help. Right now outside of email or letters phone calls . I’m stuck here at home. Any free time I get I want to spend with my wife. Our lives have been wack, my hope is that down the road by keeping in the loop at least when I get more free time I can help more.
bobeleanor 