Medicare Implements Changes to Dialysis Payments
In July 2010, the Center for Medicaid and Medicare Services (CMS) issued a final regulatory rule on the End Stage Renal Disease (ESRD) Payment System. The rule changes the way that dialysis services are paid for. In the past, Medicare paid dialysis facilities a base rate for dialysis treatment and then paid the facilities separate payments for services such as treatment supplies, certain ESRD-related drugs, and ESRD-related laboratory tests. The new rule establishes a bundled payment system resulting in one payment for all dialysis services, with the exception of certain oral medications. The new payment system went into effect January 1, 2011.
Below are some of the ways the new bundled payment system will impact patients:
Cost Sharing/Co-payments:
The new ESRD payment structure will require patients to pay a 20 percent co-payment on the entire bundled ESRD payment. The new bundled payment system will include services such as your dialysis treatments, dialysis labs and injectable medications received during treatment, like Epogen, iron, and vitamin D. Also included will be the oral form of iron and vitamin D, particularly for patients using home dialysis. Even if you do not use all of these services, you will still be responsible for sharing the costs. However, not every patient will have the same costs. Factors such as age, body size, and whether a patient has other illnesses are variables which can change your payment. Depending on the patients’ individual health condition, co-pay amounts may increase, decrease or stay the same.
Lab Tests
Payment for all lab tests that are related to dialysis care will be included in the bundle; however, those relating to transplantation will not. Lab tests ordered by your physician unrelated to your dialysis will not be a part of the bundle. It is expected that the average patient will see a 1.2 percent increase in their co-payments because of the inclusion of laboratory tests for which patients previously were not responsible.
Prescription Drugs
The new bundled payment currently includes injectable medicine such as Epogen, vitamin D, and iron. In 2014, however, all other ESRD-related oral medications that you now receive from your pharmacy will be included in the bundled payment (this includes phosphorus binders and calcimimetics).
Quality Incentive Program
On December 28, CMS issued a final rule on the ESRD Quality Incentive Program. The Quality Incentive Program is a pay-for-performance program by which dialysis facilities could receive payment reductions for failure to meet or exceed performance standards. Beginning in 2014, dialysis facilities will be scored on how they maintain patients’ hemoglobin levels and how well they administer dialysis treatments.
AKF encourages patients to continue monitoring the care they receive during dialysis treatments, particularly with the implementation of the new dialysis payment system that went into effect January 1, 2011. Don’t be afraid to ask questions and discuss the care you are receiving with your doctor.
If you have questions about how the new bundled payment system will affect you, contact our Government Affairs office at 301-984-6649.
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AKF Testifies at FDA Meeting on Anemia Treatment
On October 18, 2010, the Food and Drug Administration (FDA) and the Cardiovascular and Renal Drugs Advisory Committee (CRDAC) held a meeting to consider the results and analyses of a study to determine the impact of Erythropoiesis-Stimulating Agents (ESAs) on cardiovascular health.
The discussion included presentations from the FDA, Amgen, and members of the public, and focused on the risks and benefits associated with the use of ESA’s for the treatment of anemia in patients with chronic kidney disease. Dr. Myra Kleinpeter, AKF Board Member and Co-Chair of AKF’s Medical Advisory Committee, testified on behalf of AKF. Click here for a copy of her testimony.
The CRDAC Meeting resulted in the panel voting 15-1 to maintain approval of ESAs for patients with chronic kidney disease who have not reached the point of requiring dialysis.
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Anemia Management Resource Available
The Food and Drug Administration is requiring all drugs called Erythropoiesis-Stimulating Agents (ESAs) to be prescribed and used under a risk management program, known as Risk Evaluation and Mitigation Strategy (REMS), to ensure the safe use of these drugs. As part of the REMS, a Medication Guide explaining the risks and benefits of ESAs must be provided to all patients receiving ESAs.
AKF collaborated with other key patient organizations, including Dialysis Patient Citizens, American Association of Kidney Patients, National Kidney Foundation, Renal Physicians Association and Renal Support Network, to create an educational resource on anemia management.
The fact sheet “Treating Anemia” was designed to help patients work with their doctors to identify symptoms of anemia and discuss available treatment options.
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Patients and Lawmakers Honored at AKF’s 2nd Annual Gala, The Hope Affair
This past fall, AKF held its second annual gala, The Hope Affair, to raise awareness of kidney disease and honor heroes in the kidney care community.
The Hope Affair was held at the Mellon Auditorium in Washington, DC, to celebrate inspiration among those fighting kidney disease. This black-tie event brought together 400 guests, including Members of Congress and leaders from the renal and business communities. The American Kidney Fund successfully raised approximately $800,000 for its programs and services.
Veteran NBC news correspondent and anchor John Palmer served as the emcee for this memorable event. Best-selling author and Personal Health columnist for The New York Times, Jane Brody, was the evening’s keynote speaker.
The American Kidney Fund presented its Excellence in Leadership Award to Kent J. Thiry, Chairman of the Board and Chief Executive Officer, DaVita, Inc., for his achievements in uniting the renal community around issues of critical importance to patient care.
Two Members of Congress, Senator Kent Conrad (D-ND) and Representative Mike Rogers (R-MI), were recognized for their hard work to advance legislation that would improve the quality of care for kidney patients. Sen. Conrad received the Kidney Patient Leadership Award and Rep. Rogers received the Kidney Patient Advocate Award.
The American Kidney Fund honored patients Beverly Schroeder of Edenton, NC; Ronnie Glasper of Monroe, LA; Donald Jackson of Capitol Heights, MD; and the Rev. Oliver Johnson of Washington, DC, for their bravery in the fight against kidney disease. These patients received the American Kidney Fund’s Hero of Hope Award.
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AKF Provides Screenings at CBC Spouses
Health Fair and Breakfast
 This fall, AKF provided free kidney health screenings to hundreds of individuals at the Congressional Black Caucus Spouses Breakfast and Health Fair. The breakfast was held as part of the 40th Annual Conference of the Congressional Black Caucus Foundation. In addition to the screenings, AKF President and CEO LaVarne A. Burton joined U.S. Housing and Urban Development Secretary Shaun Donovan, CBC Spouses Chair Mereda Davis Johnson, Representative Barbara Lee of California and Representative Donald Payne of New Jersey in serving breakfast to homeless individuals at So Others Might Eat, a homeless shelter in Washington, DC.
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Make Your Voice Heard During World Kidney Day
March is National Kidney Month, and World Kidney Day will be celebrated on March 10, 2011. These annual celebrations focus on the importance of our kidneys and increasing awareness of kidney disease. During the month of March, AKF will be engaged in several activities to promote prevention and awareness of kidney disease.
AKF will celebrate World Kidney Day 2011with an advocacy training conference and Capitol Hill “Fly In” on March 9-11, 2011. AKF Advocates are encouraged to participate in this important day by educating lawmakers on the impacts of kidney disease. Don’t miss your chance to make a difference in the lives of people living with kidney disease! Join us March 9-11, for World Kidney Day activities on Capitol Hill in Washington, DC. If you are interested in attending, please email Nikia Okoye.
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Upcoming Events
Kidney Health Fair on the Hill
March 3, 2011
Hosted by the American Kidney Fund and the Congressional Kidney Caucus
Rayburn Foyer, Rayburn Building on Capitol Hill
12 p.m. – 4 p.m.
To commemorate National Kidney Month, the American Kidney Fund will partner with the Congressional Kidney Caucus, American Diabetes Association, and the American Heart Association to bring awareness about kidney disease and its risk factors to policymakers and their staff.
World Kidney Day
AKF Advocate Washington DC Fly-In
March 9-10, 2011
In recognition of National Kidney Month, the American Kidney Fund will host its 2nd annual Advocate Training and Fly-In to raise awareness among lawmakers about kidney disease and prevention.
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