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.