RenalWEB is passing along this message on federal legislation (HR 3096) for daily or nightly hemodialysis from Christopher R. Blagg, MD, and Robert S Lockridge, MD.

Introduced by Rep. Jim McDermott of Washington, the bill currently has 27 co-sponsors.
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CURRENT MEDICARE REIMBURSEMENT POLICY LIMITS ADOPTION OF MORE FREQUENT HEMODIALYSIS AND RELATED TREATMENTS

● Current reimbursement limits hemodialysis generally to three times a week. This precludes patients from enjoying the great benefits of more frequent dialysis.

● Current reimbursement creates a financial disincentive for facilities to adopt daily or nightly dialysis, even though their patient benefits are well established.

● Although direct reimbursement to dialysis facilities must be increased to allow greater access to more frequent dialysis, overall costs to Medicare would be reduced because of fewer hospitalizations and reductions in the use of drugs.

● In 2003, Medicare spending on hospitalization was up by 10%. More frequent dialysis is one way this can be reduced for ESRD patients.

● The CMS/NIH study currently about to start will take until 2009 to produce results.

LEGISLATIVE SOLUTION

● The Kidney Patient More Frequent Dialysis Quality Act of 2005: Congressman
Jim McDermott (Dem., Washington) and Congresswoman Melissa Hart (Rep,
Pennsylvania) introduced H.R. 3096 on June 28, 2005 with 18 (now 26) cosponsors.
● Key Elements of HR 3096:

• Establishment of a payment rate for more frequent hemodialysis (and equivalent treatments requiring blood access), independent of location and that takes into account the cost of more frequent dialysis, the great benefits to patient wellbeing and the reduced total costs of treatment. Rates will be defined for:
  ongoing more frequent dialysis at home or in-center
  
• Identical reimbursement rates for Method I and Method II billing.
  
• Empowerment of the Secretary of CMS to define standards of care and quality standards for more frequent dialysis in consultation with the nephrology community.
  
• Clinical judgment of the physician caring for the individual patient to decide who is a 'qualified individual'
  
• More frequent hemodialysis is defined as hemodialysis sessions or equivalent therapy requiring blood access performed 4 or 5 times per week.
  

ENDORSEMENTS
Similar legislation has been supported in the past by the National Kidney Foundation, the American Nephrology Nurses Association and the Renal Physicians Association and the American Association of Kidney Patients has encouraged "development of new treatment methods which will result in improved quality of care and clinical outcomes for kidney patients." All reports from the U.S. and elsewhere have shown that both more frequent short dialysis by day and long overnight dialysis are significantly better for patients than conventional three times a week dialysis. As a result the governments of the Netherlands, the Province of British Columbia, Canada and the State of Victoria, Australia all support more frequent dialysis.

The best argument for more frequent dialysis is the glowing testimonials from patients who have experienced more frequent dialysis and its many benefits despite the extra work required. Very few of them want to go back to thrice weekly treatment.

This treatment should be an option available to all suitable ESRD patients.

Christopher R. Blagg MD FRCP
blaggc@hotmail.com - 206-234-8791

Robert S Lockridge MD
rlockridge@lynchburgnephrology.com - 434-660-7417

This message has been edited. Last edited by: Leigh,