Medicare Dialysis Composite Rate: Good News - Bad News

Staff at Representative Nancy Johnson’s office, the Chair of the House Ways and Means Committee Health Subcommittee, have said that the reduction in composite rate for home dialysis has been eliminated from Medicare bill they are preparing.

The increase in composite rate for in-center hemodialysis has also been removed from the bill.

Further update on Congress and the proposal to cut payments for home dialysis

"Today we heard from staff at Representative Nancy Johnson’s office (she is Chair of the House Ways and Means Committee Health Subcommittee) that the provision in the proposed Medicare bill affecting the composite rate for reimbursement for dialysis has been removed. This means that both the increase in composite rate for in-center hemodialysis and the reduction in composite rate for home dialysis have been eliminated. It is clear that the magnificent outpouring of communications to Congress from so many, particularly patients, objecting to a cut in payment for home dialysis has been one of the major factors in producing this change. We thank all for their support.

The issue now will be the increase in the composite rate for in-center hemodialysis that was supported by MedPac and by many of the members of Congress. How to achieve this will have to be considered by the various societies and corporations involved with the Medicare ESRD Program. This increase was also supported generally, but if it is to occur the money has to come from somewhere in Medicare.

We will remain vigilant in our efforts to keep you posted as other new developments occur, particularly as it is expected that Congress will be finalizing the Medicare bill for consideration in the House in the very near future.

If you have questions or comments please feel free to contact us."

Christopher R. Blagg MD
blaggc@hotmail.com
Website: www.nwkidney.org

Robert S. Lockridge Jr., MD
rlockridge@lynchburgnephrology.com
Website: www.lynchburgnephrology.com

May 23, 2002 - Here is an update from Christopher Blagg, MD, and Robert Lockridge Jr., MD, on possible Medicare reimbursement cuts by Congress for home dialysis treatments.

Update on Congress and the proposal to cut payments for "Home Dialysis"

On Tuesday and Wednesday of last week we met with the health staffers of 13 members of Congress, including staffers from the two involved committees – Ways and Means and Energy and Commerce. We also met with a staffer of one of the Senators on the Finance Committee. The meetings were all cordial and gave us the opportunity to point out the importance of CAPD and CCPD, and the importance of home hemodialysis. We were able to answer all questions asked and provided them with a description of the issue based on our experience and the document of ours recently published on the Internet.

Others, such as the AAKP and the NKF representatives have also met with staff as reported in the May 16th press release from the AAKP. In addition, representatives of the other kidney-related societies and of some of the companies have also been meeting with staff. All reported that staff listened to concerns about the harmful effect the cut would have on existing and potential future home dialysis patients and to the request that this be removed from the bill.

The present situation appears to be that the provision to reduce home dialysis reimbursement probably is still there in the draft bill. Mark up of the bill now could happen in June, after the Memorial Day recess.

It was clear to us that the faxes, emails and calls to House members, particularly those from patients and other members of the renal community, are having an effect in raising the visibility of this issue in spite of the size and complexity of the whole bill. Feel free to continue your efforts so that this momentum is maintained, but it is important that you contact only the Committee chairs and the representatives from your own district rather than blanketing all committee members with messages.

We will keep you informed of developments so that, if necessary, we can ask you again for a major future effort in the event that the provision is not eliminated.

Thanks for your help. If you have questions, comments or reports on the response to your messages feel free to contact us.

Christopher R. Blagg MD
blaggc@hotmail.com
Website: www.nwkidney.org

Robert S. Lockridge Jr., MD
rlockridge@lynchburgnephrology.com
Website: www.lynchburgnephrology.com

May 17, 2002 - Gwen Gampel, on behalf of the National Renal Administrators Association (NRAA), has been meeting daily with House Ways and Means and Energy and Commerce Committee staff, and Members of these two committees, to urge them to eliminate a proposed cut to Medicare home dialysis reimbursement. The proposed cut is currently included in a draft Medicare bill the Committees will consider in the next few weeks. The NRAA also has been coordinating its efforts with Baxter and the members of our Renal Coalition.

The NRAA has been successful in convincing some Members of Congress to champion efforts to eliminate any cut in home dialysis reimbursement. But your help is needed. Please make your calls as described in the May 7th posting below.

Earlier this week, Kris Robinson, Executive Director of the American Association of Kidney Patients (AAKP), met with key House health staff, including staff of the House Committee on Ways & Means and the House Committee on Energy, to voice the concerns of America’s kidney patient community about proposed House GOP Medicare legislation that would cut Medicare payments for home dialysis treatment. Press release from the AAKP.

May 9, 2002 - In 1973, almost 40 percent of the more than 10,000 dialysis patients were treated by home hemodialysis. In 1999, with approximately 250,000 dialysis patients in the United States, only 1.3 percent were on home hemodialysis.

In an article published in 2000, Dr. Christopher Blagg explains why this modality fell from favor and how recent developments support its revival. Here is the full text of "What Went Wrong with Home Hemodialysis in the United States and What Can Be Done Now?" from Hemodialysis International.

Contact names for congressional committees have been changed and a list of the names, phone numbers, fax numbers, and e-mail addresses of the members of the Ways and Means and the Energy and Commerce Committees has been added.

RenalWEB is publishing this message from Christopher Blagg, MD, and Robert Lockridge Jr., MD, on possible Medicare reimbursement cuts by Congress for home dialysis treatments.

PROBLEM:

In Washington, DC, as the Republican leadership of the House of Representatives (and the Energy and Commerce and the Ways and Means Committees) develops a legislative proposal for Medicare reform and a prescription drug benefit under Medicare, there is a proposal that would SIGNIFICANTLY REDUCE THE COMPOSITE RATE PAYMENT FOR HOME DIALYSIS. This would be disastrous for both home hemodialysis and peritoneal dialysis.

WHY IS THIS A PROBLEM?

Inadequate payment would harm patients on both home peritoneal dialysis (CAPD and CCPD)and home hemodialysis, as it would be a major financial disincentive for dialysis units to continue these programs and an even greater barrier to the development of new home dialysis programs.

WHAT YOU CAN DO TO HELP:

As this bill is expected to be marked-up in both Committees next week, action is necessary as soon as possible. Please contact Energy and Commerce Committee Chairman Billy Tauzin (R-LA) (phone 202-225-4031/fax 202-225-0563) and Health Subcommittee Chairman Mike Bilirakis (R-FL) (phone 202-225-5755/fax 202-225-4085), and Ways and Means Chairman Bill Thomas (R-CA) (phone 202-225-2915/fax 202-225-8798) and Health Subcommittee Chair Nancy Johnson (R-CT) (phone 202-225-4476/fax 202-225-4488) by phone, fax, or email to express your opposition to a reduction in the payments for home dialysis therapies.

Do not mail letters - they are slow in getting there because of precautions with mail. Also, a link below contains the names, phone, fax, and e-mail addresses of the members of the Ways and Means and the Energy and Commerce Committees. They will be considering this legislation over the next few weeks. If any of your state's Representatives are listed (other than Washington State), you should at least also contact them.

House Ways and Means Committee members

Energy and Commerce Committee members

Committee members phone, fax and e-mail addresses

Use your own words to:

1. ASK them to support REMOVAL of this provision as it will be a disaster for home dialysis in this country.

2. INFORM them that data from the U.S. Renal Data System has shown that home hemodialysis provides the best survival for patients as well as the best quality of life and opportunity for rehabilitation and return to work, school or other activities of all dialysis treatments and maximizes patient independence and control over their own care.

3. POINT OUT that peritoneal dialysis (CAPD and CCPD) is also a home treatment, is the preferred treatment for more than 10% of patients nationwide and particularly allows new patients to go home quickly and return to work, school or other activities.

4. TELL them that interest in home hemodialysis has been growing in recent years and that new programs are starting up.

5. TELL them that several manufacturers have developed patient-friendly equipment for home hemodialysis recently.

6. REMIND them that projections are that the number of dialysis patients in this country will double over the next 10 years, while the number of nephrologists will not increase and the nursing shortage will continue. The best solution is for more patients to dialyze at home where they will also receive the most adequate dialysis!

7. REMIND them that the original intent in Congress was that "the maximum practical number of patients who are medically, socially, and psychologically suitable candidates for home dialysis or transplantation, should be so treated"

8. MOST IMPORTANTLY, if this provision passes, this will limit patients' choice of treatment.

WHO ELSE IS CONCERNED:

In addition to individual physicians, patients and dialysis programs, various organizations including the American Association of Kidney Patients, the American Nephrology Nurses Association, the National Kidney Foundation, the National Renal Administrators Association and the Renal Physicians are also concerned about this provision, as are several of the manufacturers of dialysis equipment and others.

PERSONALISE YOUR COMMENTS: If you are a patient who has been treated by home hemodialysis or peritoneal dialysis, say how this has benefited you. If you are an in-center dialysis patient, comment on whether you were given the opportunity to select home hemodialysis and CAPD or CCPD and point out that destroying these treatments will eliminate patient choice. If you are a member of the renal community, comment from your experiences.

If you have questions please feel free to email Dr. Christopher R. Blagg at blaggc@hotmail.com or Dr. Robert S Lockridge at rlockridge@lynchburgnephrology.com.

Chris Blagg, M.D.
Robert S. Lockridge, Jr., M.D.

(End of message.)

Here is the RenalWEB Topic Page on Daily, Home and Nocturnal Dialysis.