Got a good idea to improve Medicare for kidney patients? It is now time to start thinking about proposals to present Congress next year to upgrade the Medicare End-Stage Renal Disease (ESRD) program, which covers at least 75 percent of all dialysis patients. Proposal ideas can run the gamut: new Medicare benefits, increased organ donation, expanded scientific research on prevention and management of kidney disease, and improved rehabilitation opportunities and much more.

But perhaps the hottest topic right now is “pay for performance,” linking Medicare reimbursement to quality of care. Over the past year, the Centers for Medicare and Medicaid Services (CMS) (www.cms.hhs.gov), the Federal agency that manages Medicare, has promoted several new initiatives to improve ESRD program “quality” – including dialysis payment reforms, changes to nephrologists’ reimbursement and “Fistula First” (see below). CMS also expects to soon publish updated standards for dialysis facilities, called “Conditions of Coverage.”

CMS is challenging the kidney community to recommend its own quality proposals. At least three reports helped spark the healthcare quality movement. A 1999 Institute of Medicine (IOM) report, "To Err Is Human: Building a Safer Health System," alleges that 98,000 Americans die each year from preventable medical mistakes in hospitals (books.nap.edu/html/to_err_is_human/).

Two other IOM healthcare quality reports are also widely read at CMS: “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001) books.nap.edu/catalog/10027.html; and “Leadership by Example: Coordinating Government Roles in Improving Health Care Quality” (2002) books.nap.edu/catalog/ 10537.html.

What is “quality” in healthcare? Definitions differ, but two are probably most relevant to kidney patients. First, quality is meeting standards – for example, ensuring kidney patients receive the right dialysis prescription at the right time and that dialysis is delivered safely and effectively. Dialysis facilities routinely report four “quality” measures to CMS: (1) adequacy of hemodialysis (HD); (2) adequacy of peritoneal dialysis (PD); (3) vascular access; and (4) anemia management. But are others also needed? A second approach to quality is focus on actual outcomes – measurable impact on the patient health, vitality and longevity.

Although good ideas are the starting point for improving the Medicare ESRD program, these ideas must be brought before decision makers, such as members of Congress and CMS officials. At this year’s AAKP Annual Convention, on Saturday afternoon, Sept. 4, there will be a session on “Our Voices Make a Difference: Influencing Public Policy,” with practical “how to” advice on writing and visiting members of Congress and their staffs and other ways to influence public policy.

And, as always, this year’s Convention will be a great opportunity to exchange ideas. Look forward to seeing you then!

Washington Report, aakpRENALIFE, Vol. 20, No. 1, July 2004

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