September 25, 2002 - Twenty-nine senators (13 Republicans and 16 Democrats) urged Senate Finance Committee leadership to boost Medicare payments to providers before the November election. In a letter to committee leaders, the senators said, "A Medicare improvement bill simply cannot wait until next year. ... It is of utmost importance that all healthcare providers have adequate resources to provide timely and quality care to the patients they treat." Story from Modern Healthcare.(link is no longer available)
September 11, 2002 - The American Association of Kidney Patients (AAKP) has sent this letter in response to the Editor's Comment (September 10) listed below:
Gary,
Thanks very much for the opportunity to respond to your "editorial" regarding the Renal Coalition letter to Capitol Hill on several pieces of legislation.
First, AAKP never saw nor was asked to sign the "Renal Coalition" letter to Capitol Hill. As you are surprised, so are we. The letter is news to us. Even more, the working rules of the Renal Coalition are that no letter is sent in the Coalition's name without all Coalition organizations having signed on.
Second, AAKP has been actively involved in Washington, D.C. on many legislative issues, including frequent, direct contacts with Congressional staff. In fact, as reported on RenalWeb, AAKP led the fight to rollback the 20-percent cut in home dialysis payments proposed by the House of Representatives in May, despite criticisms we received from some other members of the renal community. Regarding reimbursement, AAKP's longstanding position has been that any reimbursement increases AAKP supports must translate directly into improved CARE FOR PATIENTS. When that is demonstrated, you can be sure AAKP will be on board!
Third, AAKP was born in political activism in 1969. AAKP helped lead the fight to ensure that every American with kidney disease had the right to access to dialysis � literally the right to live -- regardless of ability to pay. Political and policy issues were widely discussed at our convention just last week in Orlando. AAKP has never let up in the fight for improved care for patients, and will not, not now nor in the future. In fact, it is this single-minded focus on patients that has given AAKP UNIQUE CREDIBILITY in Washington. I don�t doubt that other groups want to piggyback on that credibility.
As you perhaps know, the "Renal Coalition" is a mix of business and professional interests, as well as patient interests. Perhaps a coalition devoted solely to patient interests is needed?
AAKP has also been concerned about the effectiveness of lobbying by kidney interests in Washington. In fact, none of the four bills you listed had any success in the House of Representations earlier this year. Should we not ask why? It is also a puzzle why the dialysis companies do not have a formal trade association in Washington. Every other health industry � hospitals, doctors, nursing homes, home health, and so on � all have powerful, prestigious trade associations. Not so dialysis companies � although no doubt they could establish a great organization. Indeed, it would be far easier for AAKP to work with one organization like that than try to continually balance sometimes competing interests.
Although the small composite rate increase would surely be helpful to companies, why isn�t the renal community pushing for other payment improvements more directly related to care? For example, the nursing home industry received a big increase in the House Medicare bill just for nursing salaries. Don�t renal nurses deserve a pay raise?
Also, AAKP is concerned about reports that rural dialysis facilities are having an especially tough time. In other areas of Medicare rural health care, Medicare pays on a cost-plus basis, rather than a straight rate as all dialysis facilities are. Where is the recognition of the needs of rural dialysis facilities?
Please feel free to contact me anytime to get the real facts.
Sincerely,
Kris Robinson Executive Director American Association of Kidney Patients 3505 E. Frontage Rd., Ste. 315 Tampa, Fl. 33607 800-749-2257 Fax: 813-636-8122 krobinson@aakp.org
September 10, 2002 - Time is of the essence for healthcare provider issues in Washington. Senate and House members returned to Capital Hill last week with a long list of healthcare-related bills on the table, but only a short amount of time to address all the issues. Story from Modern Healthcare.(link is no longer available)
There are many dialysis-related pieces of legislation fighting for approval and funding:
Glaringly absent from the list of signees in the July 31 letter below is a representative from the American Association of Kidney Patients (AAKP).
It is difficult to understand why the AAKP would not join the efforts of these other organizations to increase Medicare reimbursement for dialysis treatments.
Patients want and need high-skilled caregivers. The nursing shortage continues to worsen and nursing labor costs are increasing much faster than Medicare reimbursement. In order to attract and retain high-skilled nursing staff, dialysis facilities must compete with all other healthcare providers. When Medicare reimbursement falls far behind nursing labor increases, renal administrators must make tough cost-cutting choices. Nearly all these decisions impact the quality of patient care, patient safety, and patient well-being.
My 27 years of experience in the dialysis/nephrology field only lead me to believe that the AAKP's silence on this issue ultimately will result in greater difficulties for many end-stage renal disease patients and will hamper the efforts of these other organizations. Is it not time for the AAKP to rethink its mission and join these other professional groups in working to increase funding for ESRD treatments - so dialysis patients can "receive the best care available"?
RenalWEB would welcome a response from the AAKP clarifying their position on all ESRD reimbursement issues, including home dialysis treatments and immunosuppressant coverage.
Gary Peterson
July 31, 2002
Renal Coalition Letter to Senate Urges Composite Rate Increase
The Renal Coalition delivered a letter to each member of the U.S. Senate urging them to support a 2.4% increase in the dialysis composite rate for 2003 and 2004. The Senate is developing a Medicare provider reimbursement package, which they expect to consider this fall.
The letter urges Senators to show their support for the composite rate increases by cosponsoring S. 1605, the Conrad/Frist "Dialysis Benefit Improvement Act," which includes a composite rate increase. The letter also asks Senators to show their support for dialysis patients and providers by telling Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) that a 2.4% composite rate increase for 2003 and 2004 is a high priority for them and should be included in any Medicare bill considered by the Senate this year.
Text of the Renal Coalition Letter to the Senate:
July 31, 2002
The Honorable United States Senate Washington, D.C. 20510
Dear Senator:
The undersigned renal related organizations are asking for your help in ensuring continued access to quality dialysis care for individuals with kidney failure by demonstrating strong support for a 2.4% increase in Medicare dialysis reimbursement for 2003 and 2004.
Renal Coalition - Our organizations represent patient advocates, health care providers and health professionals in all fifty states who are dedicated to improving the care of our nation's 350,000 individuals with end-stage renal disease (ESRD) and kidney transplant patients. We are proud of the fact that recognized indicators of quality of care for these patients have shown consistent improvements in the last seven years.
MedPAC Recommendation - The Medicare Payment Advisory Commission (MedPAC) recommended a 2.4% increase in dialysis reimbursement for 2003 in its March 2002 Report to Congress. The Renal Coalition is asking that you not only support MedPAC=s recommendation for 2003, but also champion the same increase for 2004, as the House passed bill only includes an insufficient 1.2% update (i.e. a $1.50 increase per treatment) for 2004 and does not include MedPAC=s recommended increase for 2003.
Costs are Rising, Medicare Reimbursement Is Declining - Like hospitals, dialysis facilities are treating an ever sicker and older patient population, facing severe nursing shortages and are experiencing inflationary costs for supplies and biologics. According to MedPAC, Medicare dialysis treatment reimbursement is on average 4% less than the cost of a treatment and as much as 14% less than the cost for small dialysis facilities found all over rural America. While Medicare reimbursement for a few separately billable drugs used to help off-set the losses on inadequate Medicare treatment payments, this situation has seriously deteriorated to the point that Medicare is now a break even proposition or even an over all loss for small rural providers. Given that Medicare is the primary payer for 80-90% of patients in any given dialysis facility, Medicare must become a fair and adequate payer.
Access to Care Threatened By Limited Nursing Supply - Unfortunately, dialysis providers who received no Medicare reimbursement increase in 2002 and have no update formula, have to compete with hospitals for staff. Hospitals received an increase in Medicare reimbursement in 2002 and are scheduled to receive Medicare updates over the next few years. Without an inflation increase for dialysis treatments, dialysis facilities will not be able to compete with hospitals and other providers for scarce qualified nurses. This situation has already begun to create access to care problems and will potentially affect quality of care if qualified nurses cannot be found. Based on a survey conducted by the American Nephrology Nurses= Association, the nursing shortage has resulted in dialysis facilities around the country limiting their capacity, which is a first step in decreasing access to this life-saving therapy. The survey found that some Medicare ESRD beneficiaries are forced to remain in the hospital longer because no dialysis facility in the area can take a new patient or they are required to travel much longer distances to find a dialysis facility that can treat them.
Medicare reimbursement for dialysis services is at a crossroads. Unless annual updates are provided to dialysis facilities, access to life sustaining dialysis treatments will be threatened as the number of Americans with chronic kidney failure is projected to increase to more than 660,000 by 2010.
The Renal Coalition urges you to support access to quality dialysis care by cosponsoring S. 1605, a bill introduced by Senators Conrad and Frist on updating dialysis reimbursement, and by informing Senate Finance Committee Chairman Baucus and Ranking Minority Member Senator Grassley that a 2.4% increase in 2003 and 2004 is a high priority for inclusion in any Medicare bill this year. Please respond to the Renal Coalition at 2011 Pennsylvania Ave. N.W., Suite 800, Washington D.C. 20006 with your position.
On behalf of the thousands of individuals with kidney failure and those who provide them with renal related care, we thank you in advance for any support you can offer in ensuring access to life-sustaining dialysis care.
Sincerely,
William F. Keane, M.D. President National Kidney Foundation
Shelley Clark President National Renal Administrators Association
Gail S. Wick President American Nephrology Nurses' Association
William F. Owens, Jr., M.D. President Renal Physicians Association
Karen M. Sendelback Executive Director American Kidney Fund
[This message has been edited by Gary Peterson (edited 02-19-2003).]
