July 4, 2001 - The National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) is expected to announce soon that they are accepting Requests for Applications (RFAs) for a Clinical Trial of Daily Dialysis.

The proposed RFA will solicit applications to support the implementation of a carefully designed randomized trial of frequent dialysis. The overall goal is to assess the impact of more frequent dialysis on patient morbidity and mortality. It is envisioned that a planning group will be established in 2002, with the expectation that the trial will move into full implementation by 2003.

The listing is meant to provide the earliest possible alert to potential applicants in order to maximize application preparation time. While the NIDDK plans to proceed with this initiative, the publication and timing is not certain and depends on sufficient funds being available. Click here for more information on RPAs from the NIDDK web site.

August 11, 2001

Congressman Jim McDermott and Congresswoman Jennifer Dunn introduced the "Kidney Patient Daily Dialysis Act of 2001" (HR1759) on May 8, 2001. Senator John Kerry introduced a similar bill (S1303) to the Senate on August 2, 2001. This year's Medicare legislation will not be considered until some time after Labor Day when Congress returns from their summer break. To date, the grassroots effort of all of you has resulted in twenty co-sponsors of HR1759 in the Congress.

We need to generate the same grassroots effort to have Senators in your state co-sponsor S1303. Please visit your Senators' state office and your Representative's local office during their summer recess. If you can not visit please write and call their local office asking them to co-sponsor HR1759 or S1303.

Once again, Chris and I appreciate your effort to make Congress aware of this very important quality care issue for patients with End Stage Renal Disease. If you have any additional thoughts or gain any additional support, please e-mail Chris or I with the information.

Sincerely,

Bob Lockridge and Chris Blagg

Editor's note: Dr. Robert Lockridge oversees the home hemodialysis program run by Lynchburg Nephrology in Virginia. Dr. Christopher Blagg has been involved in the Northwest Kidney Centers' home hemodialysis program for decades.

• Establishment of a new payment rate for provision of daily hemodialysis (and its equivalents, hemodiafiltration and hemofiltration, independent of location) that takes into account the cost of more frequent treatments, benefits to patient well-being, and reduced total medical costs for treated patients. Rates will be defined for:
  
  • Ongoing chronic daily treatment (at home or in-center)
  • Training of patients to administer daily therapy at home
    
• Cost neutrality to Medicare
  
• Identical reimbursement rates regardless of Medicare billing method (Method I or Method II)
  
• Empowerment of the Secretary to define (in consultation with the Nephrology community) standards of care of this New Modality
  
• Clinical judgment of the physician working with individual patient to decide "qualified individual"
  
• More frequent hemodialysis is defined as hemodialysis treatment sessions, or equivalent therapy requiring blood access, performed at least 5 times per week.

Information from Dr. Robert Lockridge and Dr. Christopher Blagg:

Daily therapy is good medicine that is economically nonviable today without reforming Medicare reimbursement:

• Greater than 75 articles in the literature, over the last 20 years, consistently demonstrate patient benefit and health care savings:
  • Improved patient quality of life
  • Return to work
  • Fewer hospital in-patient days
  • Less pharmaceutical requirements
• The fact that kidneys function twenty four hours a day supports and explains observed results of daily replacement therapy
• Concept of daily therapy supported by patients (American Association of Kidney Patients - AAKP), providers (National Renal Administrators Association - NRAA) and medical professionals (National Kidney Foundation - NKF)
• Daily therapy is more expensive to providers and is not appropriately reimbursed, thus this New Modality is…
• Essentially not available to US patients today although greater than 200 patients over the past 20 years have been treated with daily hemodialysis or its equivalent in the US, Canada, and Europe

Information from Dr. Robert Lockridge and Dr. Christopher Blagg:

Daily therapy results are consistently compelling:

Information from Dr. Robert Lockridge and Dr. Christopher Blagg:

Daily Therapy Savings Impact of Daily Therapy Medicare Benefits Hospitalization Costs 23 - 63% reduction $5290 to 14,490 EPO/Drugs 32- 50% reduction $2880 to 4500 Shift to Other Payers 10 - 15% total patient cost shift to private insurers due to patient employment $7000 to 10,000 Dialysis Treatment Costs Additional cost of daily therapy assuming 50% increase in reimbursement: $10,000 per patient per year -$10,000 Annual Saving to Medicare per patient per year: $5170 to $18,990

• Patient Employment
  • Half of patients under age 65, most unemployed and covered by Medicare
  • Half can return to work when on daily therapy
  • 30 month private pay period covers half of expected duration of dialysis
    
    

The Case for Daily Dialysis: Its Impact on Cost and Quality of LifeAJKD, Vol 37, No 4 (April), 2001: pp 777-789

Canadian Study Comparing "Conventional Vs HNHD Cost and Quality-of-Life" Presented in New Orleans February 2001 at "The 21st Annual Dialysis Conference",

• HNHD provided 87% more dialysis treatments, 3.75x more dialysis hours.
• HNHD costs 82% of IHD annually.
• Cost reduction of $12,457, ($8304.66 US Dollars) annually per patient.
• Improves quality-of-life 40%