Please take the time to download the PDF file located at the link, below. If you have access to the NRAA web site, you can download a zip file titled "NRAA_Report_561". The PDF file explains in detail what CMS plans for ESRD providers in 2006.

The EPO story is not a pretty one. It takes the reimbursement for EPO down to $9.25. Not a pleasant thought after Amgen's 4.9% price increase.

Pay particular attention beginning on page 21 and then page 61. It's clear that CMS is trying to clear out the "deadwood" of dialysis providers, or, at least, that's how they see it. What they are really doing is working on behalf of the chains. But, even the chains are going to be hard pressed to survive, especially since CMS is making reimbursement a geographic issue. All metropolitan areas with high costs of living will do fairly well. Unfortunately, the midwest and the southern states will suffer. Rural dialysis providers will be kicked in the teeth without mercy.

Getting back to Amgen, something is going to have to be done. I'm certain that the chains have all worked out their discounts with Amgen, but independent providers are going to have to pull together under one consolidated buying group in order to survive. The NRAA-GPO, if leveraged properly, could be an independent providers only way out. The problem is that Amgen, who was supposed to treat the NRAA-GPO in the same manner as they did the chains, failed to do so. Not saying they didn't give a better deal than a sole provider, but it cannot be compared to the discounts and rebates chains are, most likely, getting.

In any case, everyone, no matter what your status in your facility, needs to know what's in CMS' proposed reimbursement for 2006. There is still time to comment on document CMS 1502-P. Sadly, the Medicare Modernization Act has given CMS complete control over their budget, allowing them to do anything necessary in order to balance the budget. It's simply a matter of CMS borrowing from Peter to pay Paul. There will be no new taxes to pay for Medicare's new Senior Drug program, which takes effect next year. So, CMS is taking from one provider and giving to another. It's actually somewhat logical, as I see CMS and Medicare beginning to focus on wellness programs, as opposed to "illness" programs. It's all about prevention. And, lets not forget all those drug companies who will be selling drugs to seniors with Medicare paying full price (no negotiation of pricing).

Please note that if you have dialup, it's going to take forever to download 260+ pages of PDF files. If you have Broadband, no problem. If you have dialup, see if an NRAA member will be kind enough to forward you a zip file (thanks Jeff).

Good Luck and happy reading.

Joe

Link: http://www.cms.hhs.gov/providerupdate/regs/cms1502p.pdf

I am currently in renog with Aetna USHC. Could you please share your rate!

My e-mail is dialysisjoe@hotmail.com. I'd be happy to assist you.

Sincerely,

Joe Atkins aka Dialysis Joe