S 691 and H.R. 1193 the `Kidney Care Quality and Education Act of 2007'

The Bill in the House already has 10 cosponsors - including my Congressman who I saw three times during the last week.

Here is the list - hope you can get your Representative on too:

Rep Bishop, Sanford D., Jr. [GA-2] - 2/27/2007
Rep Butterfield, G. K. [NC-1] - 2/27/2007
Rep Camp, Dave [MI-4] - 2/27/2007
Rep Cummings, Elijah E. [MD-7] - 2/27/2007
Rep Kilpatrick, Carolyn C. [MI-13] - 2/27/2007
Rep McDermott, Jim [WA-7] - 3/1/2007
Rep Reyes, Silvestre [TX-16] - 3/1/2007
Rep Schiff, Adam B. [CA-29] - 3/1/2007
Rep Terry, Lee [NE-2] - 3/1/2007
Rep Wynn, Albert Russell [MD-4] - 2/27/2007

The whole Bill is on http://thomas.loc.gov/ enter the Bill number 1193. It is 44,000 characters so HDC wouldn’t let me post something that large - maybe Dori can get on here or read it over at the Library of Congress site.

I got this question through another forum but I think it is common, I’ve heard versions before and I hear it in person so I thought I would cross post in case some of you were having a similar reaction to the new Bill.

There are many benefits to ESRD patients with this bill, however, passage of it will unfairly shift Medicare costs onto private insurance and cause a “windfall” of profits for the big dialysis chains of approximately 3 billion dollars. This is America and everyone is entitled to profits for services, but when do the profits being made by big dialysis chains start resulting in better care? The chains make about $96,959 profit per patient and KT makes 25 million. 35% of the chains profits come through private insurance for the same care as what Medicare pays for. We all know that the big chains are behind these bills so when does the money start equating to better standards of care? What do you think about private insurance reimbursing at medicare rates for the current 30 months + an additional 30 months as proposed by the White House?

If it was up to me I’d write a different Bill; I’m sympathetic with your critique but …

the President put the private insurance extension in play in his budget (his budget extended the period private insurance is primary in the event of CKD5 from the current 30 months to 60 months) but his budget did not capture those Medicare ESRD program savings to benefit Medicare beneficiaries let alone people with CKD5. HR 1193/S 691 capture those Medicare ESRD program savings for Medicare ESRD program beneficiaries.

Medicare is suppose to pay its own way but the system gets away with paying less. Cost shifting is enshrined in Medicare reimbursement rates, not just in dialysis but in all medical care, however, in dialysis providers have fewer private payers to cost shift to (as compared to hospitals). 35% of the chains revenue comes from private payers but really all provider profit comes from private payers. And no, this Bill does not address the cost shift cancer in US CKD funding. The current political buzzword or phrase in DC is “Pay Go” meaning new spending has to be off set by savings. This Bill counts about a billion to 1.5 billion dollars in savings (over 10 years) from extending the private pay period to 42 months. The uncertainty is from reckoning how many people that would be, assuming x mortality rate or y program growth.

My beef with the Bill is that I think (and have said directly to Representatives and their staff) that it is a straight fairness issue - Why should ESRD be the only Medicare program without a mechanism to account for inflation? Pay go, shmay go. Why should dialysis have an inflation cut each year? I believe the thinking is that in 2009 the renal community will have vetted a process for pooling part of the update to reward continuous quality improvement. I think we could have advocated for a framework in this Bill that anticipated that opportunity to motivate dialysis quality improvement but legislative strategy is a decision made above my pay grade.

The share price of the renal industry stocks, CEO salaries, reporting unit sales in price per dialyzor all make advocacy harder (and make me grind my teeth) but what can I do? We are tied to Medicare and changes to Medicare take an act of Congress. By creating a carrot, a bonus fund from the annual inflation adjustment, continuous quality improvement offers the opportunity to create levers that should raise quality. It will take ongoing effort; I hope future advocates for improved dialysis care will make good use of these levers - technician certification, CKD4 outreach, education (and some day screening?) - as well as coming up with new and more impactful measures of quality.

I think this Bill is a first step.

Currently there are 21 members signed on to HR 1193 in the House:

Rep Camp, Dave [MI-4] - 2/27/2007
Rep Bishop, Sanford D., Jr. [GA-2] - 2/27/2007
Rep Wynn, Albert Russell [MD-4] - 2/27/2007
Rep Kilpatrick, Carolyn C. [MI-13] - 2/27/2007
Rep Butterfield, G. K. [NC-1] - 2/27/2007
Rep Cummings, Elijah E. [MD-7] - 2/27/2007
Rep McDermott, Jim [WA-7] - 3/1/2007
Rep Schiff, Adam B. [CA-29] - 3/1/2007
Rep Terry, Lee [NE-2] - 3/1/2007
Rep Reyes, Silvestre [TX-16] - 3/1/2007
Rep Boucher, Rick [VA-9] - 3/9/2007
Rep Berkley, Shelley [NV-1] - 3/9/2007
Rep Grijalva, Raul M. [AZ-7] - 3/9/2007
Rep McNulty, Michael R. [NY-21] - 3/9/2007
Rep Hinchey, Maurice D. [NY-22] - 3/21/2007
Rep Tauscher, Ellen O. [CA-10] - 3/21/2007
Rep McCotter, Thaddeus G. [MI-11] - 3/21/2007
Rep LaTourette, Steven C. [OH-14] - 3/21/2007
Rep Gordon, Bart [TN-6] - 3/21/2007
Rep Burton, Dan [IN-5] - 3/21/2007
Rep Weller, Jerry [IL-11] - 3/21/2007

And I receved an email today that Baird is signing on. I visited a Baird staffer - Marc - when I was in DC so I’ll take credit when he is officially listed. In the Senate S 691 has 7 sponsors:

Sen Boxer, Barbara [CA] - 3/6/2007
Sen Chambliss, Saxby [GA] - 3/15/2007
Sen Cochran, Thad [MS] - 3/12/2007
Sen Coleman, Norm [MN] - 3/14/2007
Sen Collins, Susan M. [ME] - 3/12/2007
Sen Lincoln, Blanche L. [AR] - 3/14/2007
Sen Murray, Patty [WA] - 3/8/2007

So I still need to get 7 more Washington State Reps signed up and Senator Cantwell. If you don’t see your Representatives on the list drop them an email or give them a call. You can put a name and a face to the US dialysis program, dialysis does work. Ask them to come visit you on dialysis. I don’t think a member of Congress has ever visited the home of someone while they’re on dialysis, I should extend the invitation.

What ever happened to H.R. 3096 [109th]: Kidney Patient More Frequent Dialysis Quality Act of 2005? It apparently never got out of committee and died because that particular Congressional session is over and any proposed bill and resolution that hasn’t passed is cleared from the books. What a waste of effort? Now that it’s been cleared off the books, although it had over over 40 co-sponsors, we would have to start up afresh. What does that tell you about our government’s inefficiency? I got my rep to co-sponsor early last year and now it’s for naught.

Now that the Dems are the majority, it seems a more receptive Congress might be in place to get something done. From a cost perspective, and that’s what Washington now cares about, home dialysis gets you more bang for the buck that going to a center. It seems to make sence that Medicare should set up different payment schedules based upon the modality.

Rich Berkowitz
Skokie, IL

NxStage since 2/07
Dialysis since 3/03

Hi Rich. It’s great to have another person interested in expanding the dose of dialysis CMS is willing to fund. I grew up in Wilmette - I’ll be in town for Easter - but back to your question.

HR 3096 threads are here, here, here I am proud that 8 of 9 Washington State Representatives cosponsored the legislation my Congressman introduced on 6/28/2005 but it never had a Senate counterpart so by Washington DC standards it was never a serious Bill.

Here is the historic breakdown: This Bill was in effect a new version of HR1004 from the 108th Congress. HR1004 was introduced by my Congressman, Jim McDermott but it never did get a Senate counterpart, in the end HR1004 collected 28 cosponsors, including all nine WA state Representatives.

HR1004 was a new version of HR1759 from the 107th Congress, also introduced by McDermott which did have a Senate counterpart S1303 introduced by Kerry. S1303 collected exactly two cosponsors, hmmm which two Senators would cosponsor? hint they’re both from the same state, another hint - all nine of their House counterparts sponsored or cosponsored HR1759.

That’s probably more than you wanted to know but the point is that really support was decreasing or trending down for a Bill to increase the available dose of dialysis. Without a Senate counterpart there really isn’t a way to get a Bill passed. So I think this lead to a strategic decision to try a different strategy half way through the last Congress. Rep. Bass introduced The Access to Better Choice in Dialysis HR5321 on 5/9/2006. Here is a thread about that BiIl .

I think HR5321 represents the latest thinking in how to achieve the goal of getting more people more dialysis. Herewas my take on the politics.

The hope is that a new version of HR5321 will be introduced this year in the 110th Congress with a Senate counterpart. With a Senate counterpart the Bill could generate some momentum but politically I don’t know if anything will make it through the 110th but there is a chance. I look forward to lobbying for the Bill but at this point the only question mark in the Washington delegation is McMorris but even she is coming around.

OK Bill, if I understand you correctly, there is no current bill up for discussion in the 110th yet since HR5321 died in committee too. What an absolutely stupid way to run a government! Yes, I know that sessions of Congress change every two years with new elections, and I suppose the idea is there are new reps. But the truth of the matter is most reps are incumbents who are carried over from the previous session. And even if some retire or lose their seats, other sponsors or co-sponsors of previous proposed legistlation are members of the new session. And people wonder why our govenment doesn’t ever get anything accomplished.

Getting back to getting something finally done, it probably will take nothing short of some direct action. One idea is everybody on home dialysis could go to Washington and go on a dialysis strike – within a week or so we could force them to pick up our limp carcases. Or borrowing another idea from the activist era, we could all do a dialyze-in, similar to a sit-in, where we all bring our machines down for a community dialyze-in on the Capitol steps. Can you picture that with all of our portable dialyzers running on gas generators? Let all of the Senators and Representatives walk through a throng of people with needles stuck in the arms with blood flowing through and through in order for them to get to their chambers. That sure would make a statement.
In the meantime I’ll write to my rep and senators, one the 2nd highest and the other, the next possible president.

Rich Berkowitz

NxStage 2/06
In-center 3/03

I think a dialyze-in could get a TON of press. You’d need generators to run the machines… So many people have never heard of home dialysis that it could be very eye opening. Interesting idea, anyway.

[quote=Rich Berkowitz;13201]

Or borrowing another idea from the activist era, we could all do a dialyze-in, similar to a sit-in, where we all bring our machines down for a community dialyze-in on the Capitol steps. Can you picture that with all of our portable dialyzers running on gas generators? Let all of the Senators and Representatives walk through a throng of people with needles stuck in the arms with blood flowing through and through in order for them to get to their chambers. That sure would make a statement.
In the meantime I’ll write to my rep and senators, one the 2nd highest and the other, the next possible president.

Rich Berkowitz

NxStage 2/06
In-center 3/03[/quote]

I like the sound of this! Hahaha…