Dr. Beth Piraino, NKF President
As a follow-up to our post End of Life Decisions for Dialysis Patients: Update on Proposed Medicare Rule, we are pleased to report that the Centers for Medicare & Medicaid Services (CMS) have affirmed that dialysis patients who enter hospice for a terminal illness unrelated to their kidney failure may continue to receive dialysis services paid for under Medicare Part B. This is a great relief for patients and their families who have been diagnosed with a terminal illness and wish to enter hospice care. End of life decisions are not easy for anyone and hospice care can provide patients with palliative care and the psychosocial support necessary to help patients and families through this difficult time. The National Kidney Foundation is pleased that CMS continues to recognize the need for patients to have continued access to dialysis when entering hospice care for an unrelated condition.
The Centers for Medicare & Medicaid (CMS) has implemented many initiatives to ensure that dialysis facilities provide high quality care to Medicare beneficiaries. These include a pay for performance program and a website where users can compare dialysis facilities to one another, among other activities geared to monitor, track and encourage improvement in the quality of care dialysis facilities provide. Now, CMS has stated it will launch a new program later this year that rates dialysis facilities using a five star rating system. NKF wanted to better understand how patients judge quality as well as determine their knowledge of Medicare’s public reporting on quality programs. Therefore, we surveyed dialysis patients and their families through an online survey and received nearly 1,000 responses. 
The National Kidney Foundation (NKF) supports the Living Donor Protection Act (H.R. 5263) introduced today by Representative Jerrold Nadler (D-NY), along with Representative Michael Burgess, MD (R-TX) to promote organ donation and protect the rights of living donors. The NKF is a longtime leader in organ donation and transplantation in the U.S. and believes that in order to increase the national pool of organ donors, it is critical that living organ donors do not bear any unnecessary burdens or restrictions that would serve as barriers to donation. This bill prohibits insurance companies from denying or limiting life, disability and long term care insurance and from charging higher premiums to living organ donors. The bill also clarifies that living organ donors may use time granted through the Family and Medical Leave Act (FMLA) to recover from transplant surgery and finally, the bill directs the department of Health and Human Services to add information on these new protections to its materials to encourage more Americans to consider living donation.
The NKF is grateful for Rep. Nadler’s living donation efforts and for Rep. Burgess’s ongoing leadership on transplant initiatives. The NKF has advocated for these protections for years and is hopeful that this bill will increase the rate of living donation in this country and shorten the national transplant waiting list. Graft survival rates for living donor transplants are consistently higher than those of deceased donor transplants and therefore, passing this bill and increasing living donation will positively impact the health of transplant recipients. Increasing living donation also represents an economic cost-savings since fewer patients will need second or third transplants. Living donors are American heroes and the National Kidney Foundation believes they should be celebrated and their actions promoted so more will follow suit and many more lives will be saved. Take action to protect living donors today.
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.