Last minute update slips through 109th Congress

I heard this today:

At 12/8/06 1:52am, the Senate concurred with the House-passed version of HR 6111 by a vote of 79-9. It includes a provisions that would increase dialysis payments by 1.6 percent and mandate a home dialysis study. The legislation will now be sent to the President for his signature.

I am not sure how HR 6111 plays into what was passed (it appears to be an unrelated tax matter) or how the Bill numbering works with all the amendments and political maneuvering but I think this is the legislative language referred to in the message. This language was contained in HR 6048 Section 103 which Kaiser news is reporting in their Daily Health Policy Report

SEC. 103. UPDATE TO THE COMPOSITE RATE COMPONENT OF THE BASIC CASE-MIX ADJUSTED PROSPECTIVE PAYMENT SYSTEM FOR DIALYSIS SERVICES.

  (a) In General- Section 1881(b)(12)(G) of the Social Security Act (42 U.S.C. 1395rr(b)(12)(G)) is amended to read as follows:
      `(G) The Secretary shall increase the amount of the composite rate component of the basic case-mix adjusted system under subparagraph (B) for dialysis services--
  `(i) furnished on or after January 1, 2006, and before April 1, 2007, by 1.6 percent above the amount of such composite rate component for such services furnished on December 31, 2005; and
       `(ii) furnished on or after April 1, 2007, by 1.6 percent above the amount of such composite rate component for such services furnished on March 31, 2007.'.
  (b) GAO Report on Home Dialysis Payment- Not later than January 1, 2009, the Comptroller General of the United States shall submit to Congress a report on the costs for home hemodialysis treatment and patient training for both home hemodialysis and peritoneal dialysis. Such report shall also include recommendations for a payment methodology for payment under section 1881 of the Social Security Act (42 U.S.C. 1395rr) that measures, and is based on, the costs of providing such services and takes into account the case mix of patients.

The way I read that is that there is an update retroactive to January first of this year and then a second 1.6% update effective April 1 of 2007.

Section (b) is interesting sounds a lot like a request for a payment scheme such as the one proposed under 5321.

This should be more clear early next week but it does sound like good news.

[quote=Bill Peckham;11517]I heard this today:

At 12/8/06 1:52am, the Senate concurred with the House-passed version of HR 6111 by a vote of 79-9. It includes a provisions that would increase dialysis payments by 1.6 percent and mandate a home dialysis study. The legislation will now be sent to the President for his signature.

I am not sure how HR 6111 plays into what was passed (it appears to be an unrelated tax matter) or how the Bill numbering works with all the amendments and political maneuvering but I think this is the legislative language referred to in the message. This language was contained in HR 6048 Section 103 which Kaiser news is reporting in their Daily Health Policy Report
The way I read that is that there is an update retroactive to January first of this year and then a second 1.6% update effective April 1 of 2007.

Section (b) is interesting sounds a lot like a request for a payment scheme such as the one proposed under 5321.

This should be more clear early next week but it does sound like good news.[/quote]

Sounds quite good. but also I wonder…will this really be beneficial on patients having dialysis or will this only benefit the dialysis clinics? Feels like it will always be the way it has always been no? Oher than that its good to have more funds going to the dialysis community. We really need that support…

Boy talk about a maze of gobbly gook but I think my post from last night stands – the Senate passed a double update. Here is a summary of what I found, first from the Congressional Record:

CONGRESSIONAL RECORD—DAILY DIGEST December 8, 2006

Tax Extenders—House Message: By 79 yeas to 9
nays (Vote No. 279), Senate agreed to the motion to
concur in the House amendment to the Senate
amendment to H.R. 6111, to amend the Internal
Revenue Code of 1986 to provide that the Tax
Court may review claims for equitable innocent
spouse relief and to suspend the running on the period
of limitations while such claims are pending.
(See next issue.)
Subsequently, Senate concurred in the House title
amendment to the bill. (See next issue.)
During consideration of this measure today, the
Senate also took the following action:
By 67 yeas to 21 nays (Vote No. 277), three-fifths
of those Senators duly chosen and sworn, having
voted in the affirmative, Senate agreed to the motion
to waive certain sections of the Congressional Budget
Act of 1974, with respect to the motion to concur
in the House amendment to the Senate amendment
to the bill. (See next issue.)
By 78 yeas to 10 nays (Vote No. 278), three-fifths
of those Senators duly chosen and sworn, having
voted in the affirmative, Senate agreed to the motion
to close further debate on the motion to concur in
the House amendment to the Senate amendment to
the bill. (See next issue.)

[B]The Senate amendment to concur with the House amendment to the Senate amendment (can you believe that wording???) is the:

[/B]

TAX RELIEF AND HEALTH CARE ACT OF 2006 – (House of Representatives - December 08, 2006)
Then in the TAX RELIEF AND HEALTH CARE ACT OF 2006 there is this passage:

DIVISION B–MEDICARE AND OTHER HEALTH PROVISIONS
TITLE I–MEDICARE IMPROVED QUALITY AND PROVIDER PAYMENTS
SEC. 103. UPDATE TO THE COMPOSITE RATE COMPONENT OF THE BASIC CASE-MIX ADJUSTED PROSPECTIVE PAYMENT SYSTEM FOR DIALYSIS SERVICES.
(a) In General.–Section 1881(b)(12)(G) of the Social Security Act (42 U.S.C. 1395rr(b)(12)(G)) is amended to read as follows:
(G) The Secretary shall increase the amount of the composite rate component of the basic case-mix adjusted system under subparagraph (B) for dialysis services--(i) furnished on or after January 1, 2006, and before April 1, 2007, by 1.6 percent above the amount of such composite rate component for such services furnished on December 31, 2005; and
``(ii) furnished on or after April 1, 2007, by 1.6 percent above the amount of such composite rate component for such services furnished on March 31, 2007.’’.
(b) GAO Report on Home Dialysis Payment.–Not later than January 1, 2009, the Comptroller General of the United States shall submit to Congress a report on the costs for home hemodialysis treatment and patient training for both home hemodialysis and peritoneal dialysis. Such report shall also include recommendations for a payment methodology for payment under section 1881 of the Social Security Act (42 U.S.C. 1395rr) that measures, and is based on, the costs of providing such services and takes into account the case mix of patients.
Which is the relevant section from HR 6048. Could they make the process any more obtuse?

I can not see how a cut could improve dialysis care and without yearly inflation updates there is a yearly inflation cut. By law Medicare is suppose to pay its own way, meaning CMS can not consider profits from private insurers to determine fair reimbursement for CMS covered services.

Consider if Microsoft opened a dialysis unit on their campus and began treating people with Medicare primary insurance. Microsoft is a very profitable company would it be fair to not pay them at all for the services they provide Medicare beneficiaries? I’d say no.

Bill Dori, Beth

Can I just ask , What is it people on dialysis are after? What Do you three want or think dialysis should be and how should it be payed for?

I just ended my first full year on dialysis, and here are my thoughts…

Dialysis should start in a hospital set up where your doctor, works or comes to in doing so your doctor gets to see you and explain things. I had been seeing my doctor for 4 years before I went on dialysis. I never did get a chance to see him after I went on dialysis(was told was not permitted by company rules) before I changed doctors. And why I did change doctors that is one of reason. If a person can start dialysis in a hospital the person can be told about the types of dialysis and if the person wants to try home dialysis he/she can be trained right there. If the person want to go into a center the doctor can give the person a list of centers within 25miles of that hospital. Then he/she can if able or willing go to the centers and see what type of set up that each center offers.

If a person wants home dialysis in what ever form, the person has the hospital where trained to go to if the need comes up. Let take a second and think. My center is 50 miles away , my hospital is 20 miles away. My center is open Monday to Friday 8am to 5pm. The hosiptal is open 24/7. If the need should come up at any time let alone 6am on sunday . Where do I go???

You know I posted on the fact that all companies that have anything to do with dialysis are making money. And Bill you seem to be say you had a problem with drug makers making money, but you seem to think that companies that are doing dialysis are not making more money. Did I mis understand?

I know that a person can not let his/her feelings get in the way of seeking the truth.

Hey LSB Peace out , I’m looking forward to the new year.
bobeleanor

I made a mistake there is just one update. The revised language of the amendment to HR 6111 restates language from last year’s one time update and then extends the language to include a second update next April. The net result is that come April there will be a 1.6% update to the composite rate.

First from last years legislation called the DEFICIT REDUCTION ACT OF 2005:

SEC. 5106. UPDATE TO THE COMPOSITE RATE COMPONENT OF THE BASIC CASE-MIX ADJUSTED PROSPECTIVE PAYMENT SYSTEM FOR DIALYSIS SERVICES.

Section 1881(b)(12) of the Social Security Act (42 U.S.C. 1395rr(b)(12)) is amended–
I in subparagraph (F), in the flush matter at the end, by striking Nothing' and insertingExcept as provided in subparagraph (G), nothing’;[/I]
I by redesignating subparagraph (G) as subparagraph (H); and[/I]
I by inserting after subparagraph (F) the following new subparagraph:[/I]
`(G) The Secretary shall increase the amount of the composite rate component of the basic case-mix adjusted system under subparagraph (B) for dialysis services furnished on or after January 1, 2006, by 1.6 percent above the amount of such composite rate component for such services furnished on December 31, 2005.’.
This is the law that was passed last year that resulted in a one time update to the composit rate this year.

The amendment (below) that was passed early in the morning on the 8th keeps the language in section (G) above but adds “and before April 1, 2007,” and then adds “I furnished on or after April 1, 2007, by 1.6 percent above the amount of such composite rate component for such services furnished on March 31, 2007.’’.[/I]

The section requiring a report on home dialysis payment is new. Here is the relevant section again.

TAX RELIEF AND HEALTH CARE ACT OF 2006
DIVISION B–MEDICARE AND OTHER HEALTH PROVISIONS
TITLE I–MEDICARE IMPROVED QUALITY AND PROVIDER PAYMENTS
SEC. 103. UPDATE TO THE COMPOSITE RATE COMPONENT OF THE BASIC CASE-MIX ADJUSTED PROSPECTIVE PAYMENT SYSTEM FOR DIALYSIS SERVICES.
(a) In General.–Section 1881(b)(12)(G) of the Social Security Act (42 U.S.C. 1395rr(b)(12)(G)) is amended to read as follows:
(G) The Secretary shall increase the amount of the composite rate component of the basic case-mix adjusted system under subparagraph (B) for dialysis services--(i) furnished on or after January 1, 2006, and before April 1, 2007, by 1.6 percent above the amount of such composite rate component for such services furnished on December 31, 2005; and
``(ii) furnished on or after April 1, 2007, by 1.6 percent above the amount of such composite rate component for such services furnished on March 31, 2007.’’.
(b) GAO Report on Home Dialysis Payment.–Not later than January 1, 2009, the Comptroller General of the United States shall submit to Congress a report on the costs for home hemodialysis treatment and patient training for both home hemodialysis and peritoneal dialysis. Such report shall also include recommendations for a payment methodology for payment under section 1881 of the Social Security Act (42 U.S.C. 1395rr) that measures, and is based on, the costs of providing such services and takes into account the case mix of patients.
So the net effect will be a one time 1.6% adjustment to the composite rate.

[QUOTE=bobeleanor;11529]Bill Dori, Beth

Can I just ask , What is it people on dialysis are after? What Do you three want or think dialysis should be and how should it be payed for?

I just ended my first full year on dialysis, and here are my thoughts…

Dialysis should start in a hospital set up where your doctor, works or comes to in doing so your doctor gets to see you and explain things. I had been seeing my doctor for 4 years before I went on dialysis. I never did get a chance to see him after I went on dialysis(was told was not permitted by company rules) before I changed doctors. And why I did change doctors that is one of reason. If a person can start dialysis in a hospital the person can be told about the types of dialysis and if the person wants to try home dialysis he/she can be trained right there. If the person want to go into a center the doctor can give the person a list of centers within 25miles of that hospital. Then he/she can if able or willing go to the centers and see what type of set up that each center offers.[/QUOTE]

I’m appalled that your doctor was not allowed to visit you at your former dialysis clinic because of clinic “rules.” The only reason I can imagine why your doctor could not visit you would be if the clinic was “closed” (had its own medical staff) and your doctor did not have privileges to practice there. There are clinics that closed and have their own physicians and others are “open” and allow any area nephrologists to admit and follow patients. If your doctor wasn’t on staff at your former dialysis clinic, I can’t imagine your former clinic allowing your doctor to prescribe your dialysis treatments there. Who said that your doctor wasn’t allowed to see you at dialysis? If I were on dialysis, I wouldn’t go to any clinic that had rules prohibiting my kidney doctor from coming to see me. I would find out what clinic my doctor practiced at and go there – unless of course that clinic didn’t offer home dialysis. If that was the case, I’d change doctors.

So far as having all patients start in the hospital, inpatient care is much more expensive than outpatient care for everyone (Medicare, insurance, and patients). Hospitals don’t admit patients who are not sick enough to require hospitalization. Most patients starting dialysis are not this ill. When I started working in dialysis patients routinely started dialysis in the hospital.

Many hospitals are not Medicare certified to offer chronic dialysis or home dialysis training. Dialysis and home dialysis are specialized services and staff at hospitals where dialysis is not offered may know little about it and may provide as much misinformation as correct information.

I have never seen a study that compared patient education provided by hospitals with education provided by doctor’s offices or dialysis clinics. In general, I believe patients are not as well informed as they should be about kidney disease and treatment options, no matter where they start dialysis and this is pretty much what patients have said when researchers ask them.

Would you suggest that patients who do home dialysis live within a set distance from a hospital? If so, I think I’d vote against this. I suspect there are patients in some of the less populated areas of the country like the plains or mountain states where people may not have access to a hospital that offers chronic dialysis, including home dialysis training for PD and/or HD.

In our economy, money is a motivator for individuals and for companies. I believe that everyone should expect companies to make a reasonable profit because if they lose money, they will go out of business pretty quickly. Even “non-profit” companies make a profit, but the “profit” is returned to the business to pay workers and improve the business. Some businesses in every industry make obscene profits. Some dialysis providers’ charges jeopardize patients (and sometimes spouses’) jobs. Whenever Dori and I talk with corporate personnel, we caution them to consider the long-term effects of their charges.

Finally so far as things I would suggest, I think patients should be educated about how to protect their kidney function when their kidney disease is diagnosed. They should be told how to read their labs, what the results mean, how to protect their vessels, drugs to take and to avoid, lifestyle behaviors that help and hinder kidney function, etc. They should be told about all types of treatment (including no treatment) and the pros and cons of all treatments. They should be told about pre-emptive transplant and encouraged to look at adult members of their family and friends as potential living donors. This should occur long before their GFR is 20 where the transplant program could transplant them. Patients with Type I diabetes should be told that kidney-pancreas transplant is an option and that Medicare covers it. They should get honest information about the costs of care and sources of help to pay these costs. They should be told what things can help them live a long and healthy life once kidney failure occurs and what complications may arise even if they do everything right. Patients should not be victimized or made to feel guilty. Patients should not be discharged just because they don’t follow their treatment plan perfectly. How many professionals could stick to the kidney treatment plan 100%?

The yearly inflation cut is one problem, what was passed is a band aide for one problem. The additional language around looking at payment for additional treatments could lead to improvement in another problem area - dialysis dose restrictions embedded in the Medicare payment rules. These problems effect all US providers and through the providers we dialyzors. This legislation looks like a good first step, a deposit on the fairness the renal industry is due, and may receive from a Congress that will come to work in a month. But even a sympathetic Congress will not bring CKD5 nirvana.

A problem in your part of the US may or may not have a national solution but know this there will always be something to fix. And just like everything else in the world the longer a problem is ignored the harder it will be to fix when you eventually must. If you see a problem with CKD5 services from you experience then I encourage you to work the problem. Make the “system” better for the next person. Find the right lever and you can move the world. It could be at the federal, state or local level, all I know how to do is keep trying.

Bob, you asked for a vision. You asked what I want or think dialysis should be and how should it be paid for? That’s a big question but one thing is for sure, dialyzors should be able to receive as much dialysis as often as they like at home or incenter no matter what their address. There are real tradeoffs between economic efficiency and dialyzor-centered-ness. I favor the dialyzor because I think society benefits from investments in people. When an 80 year old man can be a father and a grandfather; when a 30 year old mom can be a mom for many years, that is a good investment. Hmmm, if I was in charge …

You’d know if the dialysis was working by measuring the lifespan of the dialyzor’s blood cells and counting the hospital stays/days they avoided. I’d give $25 quarterly rebates to dialyzor’ s who pay Medicare Part B premiums and control their phosphorus, potassium and maybe albumin.

I’d end the 30 month private primary window and make Medicare primary in stage 4. CMS would pay 80% of about $210 per treatment. CMS would buy EPO directly, negotiating prices based on their buying power. Dialyzors would receive another $25 premium break by self-injecting and maintaining a proper hemoglobin. If a unit provided EPO in the lines during treatment they’d receive a small injection fee.

A dialyzor doing as much for themselves as expected would be a success and expectations would be high.

That’s my start of a vision I still need to come up with a viable Method II option - the highest form of self-dialysis. And I should address how new technology and improvements to clinical standards would be encouraged and adapted but my dialysis run is nearly over.

Hi Folks

We can if you folks want start a new thread called “what do we want from dialysis” I leave that up to you guys.

This am I saw this and early on I found the same issues only aimed at the consumers, let see how both work.

bobeleanor

Hi Folks

Sorry in reading the paper I found this and for those like me , I recall being in the hospital in my childhood having doctors came in with an older doctor and young interns listening to the older doctor talk. Then the young interns would ask me question and stick small pins in my feet ,while I look the other way to see if I had feelings in my lower limbs.

bobeleanor

[quote=Beth Witten MSW ACSW;11534]I’m appalled that your doctor was not allowed to visit you at your former dialysis clinic because of clinic “rules.” The only reason I can imagine why your doctor could not visit you would be if the clinic was “closed” (had its own medical staff) and your

Beth,

Well done except for one thing - what is an “obscene profit”?

Erich

[quote=Bill Peckham;11535]The yearly inflation cut is one problem, what was passed is a band aide for one problem. The additional language around looking at payment for additional treatments could lead to

Bill,

Thank you for your post and keeping us current. I really appreciate it.

Your vision is pretty extraordinary as well. However, for now I’d have to skip the $25.00 EPO injection rebate. I know, I’m sticking myself with two 15s six times a week what’s the problem with a few little EPO pokes? It is just more convenient through the machine. Quite frankly, between stacking boxes, recycling boxes, opening boxes I just need a little bit of convenience.

Now if the the rebate were $45, well now maybe were talking. And when I add the Nx Stage Pureflow to my Stage well, I won’t have so many boxes. Always looking for solutions.

Peace, Erich

[quote=TheRiverdude;11548]
Your vision is pretty extraordinary as well. However, for now I’d have to skip the $25.00 EPO injection rebate. I know, I’m sticking myself with two 15s six times a week what’s the problem with a few little EPO pokes? It is just more convenient through the machine. Quite frankly, between stacking boxes, recycling boxes, opening boxes I just need a little bit of convenience.

Now if the the rebate were $45, well now maybe were talking. And when I add the Nx Stage Pureflow to my Stage well, I won’t have so many boxes. Always looking for solutions.[/quote]

It could be an incentive for you to go home - you’d manage your own EPO/hematocrit to receive the discount; if you were home whether you injected into the lines or your arm it would be up to you.

A $45 rebate would still be a bargin if you would self inject. I believe injection saves 20% over using the lines so even at a low maintanance dose of EPO you’d save way more then $45 a quarter by injection into the muscle.

(b) GAO Report on Home Dialysis Payment.–Not later than January 1, 2009, the Comptroller General of the United States shall submit to Congress a report on the costs for home hemodialysis treatment and patient training for both home hemodialysis and peritoneal dialysis. Such report shall also include recommendations for a payment methodology for payment under section 1881 of the Social Security Act (42 U.S.C. 1395rr) that measures, and is based on, the costs of providing such services and takes into account the case mix of patients.
Dori what do you see in this provision? Taking a second look, I think I was guilty initially of seeing what I wanted to see in it, a closer read leaves me feeling suspicious. I hope this is not another attempt to cut home treatment reimbursement to “costs” even if the “savings” were used to increase training reimbursement.

You’re not the only person to have that reaction, Bill. Folks are asking for written clarification of that piece of the legislation. The consensus is that it’s meant to figure out how much of a barrier the low training reimbursement is. But it could easily be taken another way (“Do we really have to pay the same for home dialysis as we do for in-center?”) if it’s not made clear.

Like others, I’m concerned about what the GAO will find. It’s not like the GAO hasn’t already done a similar study however it didn’t focus entirely on home treatments. A GAO Report written done in 2004 based on 2001 data examined composite rate payment to dialysis facilities related to the costs of providing services both in large and small facilities and for home training and home dialysis.

So far as home dialysis is concerned, here’s some of what the report states:
…In addition, composite rate payments for home dialysis treatments far exceeded the costs of those services, but payments for home dialysis training were well below the costs of those services. (page 22)

In addition to the imbalance in payment between composite rate services and separately billed drugs, an imbalance exists between payments for home dialysis treatments and home dialysis training. Two industry representatives and representatives of a patient advocacy organization we interviewed stated that Medicare payments for home dialysis training do not cover the costs of the service. We found that in 2001, the unadjusted payment-to-cost ratio for composite rate payments for home dialysis treatments was 1.11 and for home dialysis treatments and training combined was 1.04.(40) The unadjusted payment-to-cost ratio for composite rate payments for home dialysis training alone was 0.38, indicating that payments were well below costs. A perception that facilities are losing money on the initial home dialysis training, even though payments are above costs for the training and treatment combined, may serve as a disincentive to offering the home dialysis treatment method. (page 25)

[I]Several studies, each of which evaluated the costs of one to two facilities, have found that facility costs increase upon implementation of daily hemodialysis.(47) Industry representatives reported that despite the possible benefits of daily hemodialysis, it is not currently financially feasible to offer it to a large number of Medicare beneficiaries because Medicare does not routinely pay for more than three dialysis treatments per week. However, if beneficiaries who undergo daily hemodialysis have a reduced need for other Medicare services, such as drugs and inpatient stays, the Medicare program may realize overall cost savings.

Research currently being conducted by the National Institutes of Health (NIH) may provide more rigorous data on daily hemodialysis, although it will not determine whether there is an overall cost savings to Medicare. With partial funding from CMS, NIH has funded four centers to test whether it is feasible to randomize a representative sample of patients into either conventional or daily hemodialysis. The trials will track a number of patient outcomes for at least 6 months, including anemia, nutritional status, blood pressure, medication use, and hospitalizations, but they are not designed to enroll enough patients to conclusively determine whether differences in mortality or hospitalizations are significant. Trial results, which will not be available until 2007, will determine whether NIH should continue with a large-scale trial that would measure the impact of more frequent dialysis on mortality or cardiovascular outcomes or both.[/I] (page 27)

Several external reviewers commented on access issues specifically related to home dialysis. NRAA agreed with our finding that payment for home training is inadequate and therefore serves as a barrier to home dialysis. RPA agreed that one reason for low utilization of PD is that PD patients use less of the profitable separately billed drugs. AAKP provided the same assertion and added that the lack of training for nephrologists serves as a barrier to home dialysis. (page 30)

The HHS Office of the Inspector General has also looked at home dialysis, especially the difference in Method I and Method II payments. Method II suppliers are allowed to charge almost $500 a month more for CCPD patients ($1974.45) over what they’re paid for CAPD or home hemo ($1490.85). This is also more than what facilities are allowed to charge for a Method I patient on any treatment modality for the same supplies/machine and Method II suppliers don’t have to provide the staff support that a clinic must provide under the composite rate for a Method I patient. For a Method II patient, Medicare only allows the facility to bill $121.15 for the patient having access to the nurse, dietitian and social worker and all clinic visits and phone calls during the month. Not surprisingly, this report shows that higher payments for Method II for CCPD incentivized CCPD and the number of patients choosing Method II to grow during the study period. The OIG recommended that payment be consistent if the same supplies are provided.

Personally, I wish that someone would advocate for higher payment for any dialysis treatment that requires the use of a machine because buying or renting a PD or HD machine increases the cost to provide treatment significantly.

[quote=Bill Peckham;11549]It could be an incentive for you to go home - you’d manage your own EPO/hematocrit to receive the discount; if you were home whether you injected into the lines or your arm it would be up to you.

A $45 rebate would still be a bargin if you would self inject. I believe injection saves 20% over using the lines so even at a low maintanance dose of EPO you’d save way more then $45 a quarter by injection into the muscle.[/quote]

I am at home and on the road - I’m “Stage’n it.” Have been since April, 2006. Wouldn’t want it any other way. Erich

The LA Times has an article online Congress closes with a pork-filled flourish that includes this statement:

“However, Rosenbaum said that the Medicare payment advisory panel made “tons of recommendations all the time” and that other worthy providers — such as community clinics serving the poor — were often overlooked.”

This is unfair. Dialysis is the only disease that qualifies a person for Medicare regardless of age. Dialysis is Congress’s problem because they made it their problem in 1972. Dialysis is a federal responsibility because that is the law.

It is about time Congress stepped up to it’s legal responsibilities. Dialysis is the only Medicare program without an annual inflation update structure. Inflation happens in dialysis, without an annual update there is an annual inflation cut.

It would be nice if there was a frame work to update dialysis paid for by Medicare, then the large dialysis providers could save their lobbying money for patient care. I have a hard time understanding how the LA times can decry the “K Street Project” without pointing out how people advocating for meritorious issues - like modernizing the US dialysis delivery system - are extorted to get any legislative attention or traction.

Congress has legal responsibilities - funding Medicare is big one.

[quote=Bill Peckham;11698]The LA Times has an article online Congress closes with a pork-filled flourish that includes this statement:

This is unfair. Dialysis is the only disease that qualifies a person for Medicare regardless of age. Dialysis is Congress’s problem because they made it their problem in 1972. Dialysis is a federal responsibility because that is the law.

It is about time Congress stepped up to it’s legal responsibilities. Dialysis is the only Medicare program without an annual inflation update structure. Inflation happens in dialysis, without an annual update there is an annual inflation cut.

It would be nice if there was a frame work to update dialysis paid for by Medicare, then the large dialysis providers could save their lobbying money for patient care. I have a hard time understanding how the LA times can decry the “K Street Project” without pointing out how people advocating for meritorious issues - like modernizing the US dialysis delivery system - are extorted to get any legislative attention or traction.

Congress has legal responsibilities - funding Medicare is big one.[/quote]

Well at least we got a small victory? A one time increase of 1.6% …Ummm, what bothers me is this…

Dialysis scored “not because dialysis patients have the most meritorious case,” said Sara Rosenbaum, professor of health law and policy at George Washington University, but because the industry is “effective on Capitol Hill.”

My goodness, as patients…don’t you feel owned? Commodity? Seems its money that talks, not patient’s voice?

The “best” thing is that if the average Medicare composite rate is $140 per treatment, an additional 1.6% will bring a windfall to dialysis clinics of $2.24 per treatment or about $349.44/year assuming the patient is not hospitalized in that year. If a clinic has 100 patients, this update will add $34,944 to the clinic’s annual revenue. This is a drop in the bucket compared to the costs of running a dialysis clinic and wouldn’t even pay the salary for one nurse. Maybe the LA Times needs to hear it framed this way.