In the last issue of aakpRENALIFE (July 2004), we asked the question, “Got a good idea to im-prove Medicare for kidney patients?” We are predicting Congress will pass new Medicare legislation next year. Given that Medicare is the health insurance plan for most end-stage renal disease (ESRD) patients, now is the time to consider what Medicare improvements AAKP should recommend to Congress.

In thinking about this task, consider the views recently expressed by Robert Nardelli, CEO of Home Depot, on the television show Charlie Rose. Mr. Nardelli spoke about his passion for quality at his company. To paraphrase Mr. Nardelli: Here is my simple belief. There is an infinite capacity to improve the healthcare of kidney patients. There is simply no way we are doing the best job possible.

How to improve Medicare for kidney patients? Two bills introduced in Congress this summer offer some ideas.

In late June, Sen. Max Baucus (D-MT) introduced S. 2562, the “Medicare Quality Improvement Act of 2004.” Baucus described the goal of his bill thus:

[My bill] would establish a mechanism to pay for quality in the… End-Stage Renal Disease Program… through bonus payments for the best quality nationwide and bonuses for improving from one year to the next.

To determine which clinics receive bonus payments, the U.S. Department of Health and Human Services would establish a quality scoring system. The funding for the quality program would come from a two percent reduction in payments to all dialysis clinics. The Baucus bill was inspired by a Congressional advisory agency, the Medicare Payment Advisory Commission (MedPAC).

On July 7, the second bill was introduced by Sen. Kent Conrad (D-ND), S. 2614, the “ESRD Modernization Act of 2004.” Conrad offered this view of his legislation:

Since the inception of the Medicare ESRD program, we have made enormous strides in extending the lives and the quality of life of patients with kidney failure. If we are to continue that course, we must allow the program to keep pace with advances and changes in the delivery of services. We must also ensure that patients receive the best information possible so they can make informed choices and provide incentives that promote the highest quality of care. The End-Stage Renal Disease Modernization Act is a comprehensive bill that moves the program in that direction.

The Conrad bill, developed with the dialysis industry, would provide an annual inflation update for Medicare dialysis payments. The dialysis industry complains – correctly – that dialysis services are the only Medicare services that do not have an annual update formula in law – unlike, for example, hospitals and doctors. In the case of doctors, the update formula is a disaster. Due to a formula flaw, doctors will receive a five percent cut per year in their Medicare fees for the near future – unless Congress makes an expensive fix.

The Conrad bill also includes provisions on chronic kidney disease (CKD) and ESRD patient education, home dialysis and payment review for surgical access procedures and nephrologists.

As always, AAKP encourages patients to make their own evaluations of public policy ideas. You can read each bill online at THOMAS, Congress’s legislative information service, thomas.loc.gov. MedPAC’s dialysis quality recommendations are online by clicking here.

Over the next year, AAKP, working with our members, will design an updated public policy agenda. Send us your thoughts on how quality of care for kidney patients can improve to info@aakp.org or call and personally share your stories with us.

Washington Report, aakpRENALIFE, Vol. 20, No. 2, September 2004

Back