Integrated care bill divides renal community

A bill that would allow dialysis providers to build their own integrated care networks has run into opposition from some of the smaller dialysis companies who say the legislation favors large providers and would limit patient choice.

The Dialysis PATIENTS Demonstration Act passed the House Ways and Means Committee Sept. 8 (H.R. 5942), and has been introduced in the Senate (S. 3090). The legislation has been supported by the two largest dialysis providers in the country, Fresenius Medical Care and DaVita Kidney Care.

“We believe it is important for policymakers to examine novel models of care coordination for kidney patients,” said Franklin Maddux, MD, Kidney Care Partners (KCP) chair and chief medical officer at Fresenius Medical Care North America. “We believe that dialysis facilities, nephrologists, and other providers can and should partner to coordinate Medicare benefits for ESRD patients with the goal of truly quarterbacking patient care. ”

“Since KCP regards itself as a consensus driven organization representing both the CKD and ESRD community, along with the fact that there is not community consensus around the bill, KCP has opted not to take a formal position on this bill,” a spokesperson for KCP told NN&I.

Smaller dialysis providers and some patient and provider associations, including Dialysis Clinic Inc., Northwest Kidney Centers, the National Renal Administrators Association, American Society of Transplant Surgeons, the American Society of Transplantation, and the American Association of Kidney Patients, have all expressed opposition to certain aspects of the bill.

In letters to the bill’s sponsors and public statements, these organizations have said they fear the bill would lead to further market consolidation because smaller dialysis providers would be unable to provide the necessary capital to support another integrated care model.

“NRAA believes the best route for enhancing care coordination is increasing utilization of the End Stage Renal Disease (ESRD) Seamless Care Organizations (ESCOs) as a current integrated care vehicle or reforming Medicare Advantage ESRD SNP’s and providing incentives and pathways for the inclusion of supportive services such as counseling,” the association said in a statement.

The organizations also expressed concern with the proposed demonstration’s enrollment procedures, and the burden it might put on patients. And unlike the ESCOs, the demonstration does not require nephrologist ownership.

NN&I asked Doug Johnson, MD, vice-chairman of the board of directors for Dialysis Clinic Inc., to explain his opposition to the bill. We also asked Allen Nissenson, MD, the chief medical officer for DaVita Kidney Care, to describe what he sees as the bill’s benefits. -by Rebecca Zumoff

Let us know your thoughts on the bill in our comment section, or send an email to rzumoff@nephrologynews.com.

Editor’s note: An earlier version of this article said the Renal Physicians Association has expressed opposition to this bill. RPA president Rebecca Schmidt has said the association does support the intent of the bill, but has expressed concerns over certain aspects of the legislation that must be reconciled before they can support it. The RPA letter to the legislators is available on the association’s website.