On July 21, 2014 the Kaiser Family Foundation released a report on out-of-pocket expenses paid by Medicare beneficiaries. Not surprisingly, the report identified that individuals with end-stage renal disease (ESRD) have the highest out of pocket costs associated with their care, spending on average in 2010, $6,918. Since 1972 the Medicare ESRD program has been a life-saving safety net for millions of Americans who have experienced kidney failure, but the cost of care to patients for dialysis and transplantation can still be high, particularly when patients do not have access to supplemental insurance.
You may have heard today that the U.S. Court of Appeals for the District of Columbia Circuit issued a 2-1 decision that could threaten the future of health insurance premium subsidies under the Affordable Care Act (ACA). This is relevant in the 34 states where the federal government runs the exchange under Healthcare.gov. Then just a few hours later, the U.S. Court of Appeals for the Fourth Circuit ruled on a similar case that premium subsidies continue to be permissible. So what does this mean for the future of premium assistance in the Marketplace plans? In short, today’s rulings do not change anything in the near-term.
As we explained last week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on July 3, 2014 that will change how dialysis facilities are paid and how quality in the facility is measured. Last week we focused on the changes to the payment, and this week we focus on the quality changes.
The Medicare end-stage renal disease quality incentive program (QIP) reduces Medicare payments to dialysis facilities that do not meet certain quality standards. The idea, commonly known as pay for performance, is meant to encourage healthcare providers to improve the quality of care they deliver. CMS measures performance through a defined set of quality measures. Each year, every dialysis facility is given a total score based on its achievement of these quality measures as compared to the national average and each facility’s year over year improvement in the measures. If facilities don’t achieve a satisfactory performance score, they receive a reduction in payment ranging from 0.5% to 2%.
Your Members of Congress are working in their home states for the month of August, and you can schedule time to meet with them!
While the letters you have been sending to Congress throughout the year are an integral part of raising awareness and voicing concerns about legislation, sharing your personal story face-to-face with your Members often results in a greater impact.
If you want to meet with your Members during their August recess, contact us. We will instruct you on how to request a meeting and provide tips on how to prepare, as well as important information about our legislative priorities:
Contact us for all the information you need to meet with your Members in August!
On July 2, 2014 the Centers for Medicare & Medicaid Services (CMS) released its annual proposed rule on dialysis payment and quality. This week, we address changes to the payment and its effect on patients’ access to dialysis. Next week, check back as we discuss proposed changes to quality measures that facilities are judged on.
As expected, CMS proposes to keep payment for dialysis services relatively flat in 2015. However, proposed changes to how CMS calculates annual updates to payment will result in a cut to rural dialysis facilities by half a percent next year and likely another half percent in 2016. This is because CMS is proposing to use more recent information on dialysis facility costs to determine how much they should be paying dialysis facilities.
Dr. Beth Piraino, NKF President
Currently dialysis patients who have a terminal illness that is unrelated to their kidney failure can choose to enter hospice care and still receive dialysis paid for by Medicare. However, under a proposal by the Centers for Medicare & Medicaid Services (CMS), this policy could change. That’s because CMS is proposing to expand the definitions for terminal illness and related care, which could effectively require hospice providers to pay for dialysis under their current payment even when the patient may be dying of another condition or disease unrelated to their kidney failure. However, the Medicare payment for Hospice is not enough to cover dialysis treatments in addition to other treatments terminally ill patients need. Therefore, it is unlikely that most hospice providers will cover dialysis care, leaving patients and their families to choose between giving up dialysis and entering hospice or continuing to dialyze, but give up the supportive care and psychological benefits that hospice providers deliver.
The NKF has long advocated for food labels that will enable kidney patients as well as the general public to make informed choices about foods they consume. Last week, Lisa Gutekunst, a renal dietitian who serves on NKF’s Council on Renal Nutrition, traveled to Washington to voice our concerns.
The Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 4814), introduced by Representatives Tom Marino (R-PA) and John Lewis (D-GA), aims to promote chronic kidney disease (CKD) research and education, expand care coordination efforts and protect access to care for dialysis patients. We need your help to improve care for CKD patients.
The Food and Drug Administration (FDA) needs to hear from you on proposed changes to the food label. The FDA is proposing to add the amounts of calcium and potassium to the nutrition facts on food labels. This is a great win for people with kidney disease as it will promote better tracking of calcium and potassium intake. People with kidney disease often need to decrease the amount of potassium and calcium they eat and these changes can help patients follow their dietitians’ recommendations much more easily.
On May 1, 2014, the House Energy and Commerce Committee launched the 21st Century Cures Initiative to help Members of Congress gain greater insight on the barriers to developing new cures and improved treatments for various diseases. To make sure that treatments and cures for kidney disease are part of the conversation, the National Kidney Foundation issued comments on the need for the federal government to expand its efforts to facilitate cures, treatments and research for kidney disease. NKF is excited to see Congress launch a national discussion on how to speed up development of new treatments for diseases and we will continue to participate in this ongoing initiative to ensure that the needs of kidney patients are heard. You can also contribute to NKF’s future comments on the issues by sharing your thoughts and experiences through this brief survey.
Learn more about the 21st Century Cures Initiative here.