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Will the proposed PATIENTS Act limit access to transplantation?
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View: The PATIENTS Act would limit access to transplantation
Editor’s Note: The American Society of Transplantation has expressed opposition to the Dialysis Patient Access to Integrated-care, Empowerment, Nephrologists and Treatment Services Demonstration Act, also known as the PATIENTS Demonstration Act, saying it would limit patient access to transplantation. The American Society of Transplantation joins dialysis provider Dialysis Clinic Inc., the American Association of Kidney Patients and the Kidney Care Alliance, which note the act would limit patient choice and favors the country’s two largest for-profit dialysis organizations. Below are comments from the American Society of Transplantation, as well as a response from Franklin W. Maddux, MD, FACP chief medical officer of Fresenius Medical Care North America.
“As introduced, H.R. 4143 and S. 2065, the Dialysis PATIENTS Demonstration Act seeks to promote innovation, efficiency and the improvement of the quality of care for patients receiving kidney dialysis. Stakeholders in support of the legislation have stated that they believe patient care will be improved through the fostering of greater integrative and coordinated care for the end-stage renal disease (ESRD) population,” the board of the American Society of Transplantation (AST) wrote in comments on its website.
However, the organization said the legislation would significantly compromise patient access and referral to organ transplantation by restricting the freedom of patients to choose their dialysis provider — some who may not be advocates of transplantation.
“The ability to choose providers serves as an incentive for innovation and improvement in the quality of care delivered regionally. This patient choice must be preserved ... and not relinquished to for-profit entities focused largely and primarily on the business of administering dialysis,” the AST wrote. “Do patients, physicians and the nephrology community wish to entrust the identification, referral and approval/access for kidney transplantation to for-profit dialysis organizations? How do these organizations disentangle themselves from the strong financial incentives (contained in S. 2065 & H.R. 4143) not to transplant?”
The act would allow dialysis organizations to bear full risk for the care of the ESRD population, the AST wrote. “For the first time, it will allow dialysis providers to acquire or create insurance companies with little or no effort, allowing them to be the at-risk entity (Medicare Advantage Plans). Given the substantial capital and regulatory requirements required to assume risk, the Dialysis PATIENTS Demonstration Act will likely create an exclusive policy landscape and opportunity for the two large dialysis organizations: Fresenius Medical Care and DaVita Health.
“Alternative payment models (hospital ACOs) are the future of medicine, including the care of ESRD patients,” the AST wrote. “These models are based on caring for a population, cradle to grave. However, as currently introduced, S. 2065 & H.R. 4143, the Dialysis PATIENTS Demonstration Act relinquishes this care to for-profit private sector companies.”
- Reference:
- www.myast.org
Counterview: The PATIENTS Act will improve health outcomes and access to transplantation
The Dialysis PATIENTS Demonstra-tion Act will increase the quality of care for patients with kidney failure and lower overall costs while recognizing that transplantation is always the first and best option for any patient with end-stage renal disease.
The American Society of Transplantation unfortunately opposes the bill by arguing it will compromise patient access and referral to organ transplantation. These unsubstantiated claims create a misleading view of the proposal’s goal to transform and improve care for all patients with end-stage renal disease (ESRD). The truth of the matter is the proposed bill includes safeguards designed to ensure there are not disincentives to renal transplant. In fact, these safeguards go well beyond the passive approach toward transplant in today’s ESRD seamless care organization program (ESCO). Indeed, aligning the financial incentives of all stakeholders caring for patients with ESRD will maximize the total number of transplants performed.
The PATIENTS Act is specifically geared to patients whose primary insurance is Medicare. For Medicare primary patients, the cost savings of transplant vs. in-center dialysis would involve a break-even point within the first 8 to 12 months. When shared savings are amortized annually, all participants would realize financial benefit from increasing the total number of transplants. The PATIENTS Act also mandates education and counseling around transplantation, specifically stating that all participants will receive “education regarding the importance of transplantation as the best health outcome.”
Patient choice will be preserved as nobody is forced to participate in the program. If a patient chooses to receive care from a participating facility, the patient has 75 days to opt out and will not experience any disruption in care. However. becoming part of a more integrated program with improved care coordination will only help patients better navigate frequent barriers that result in missed treatments and poorer outcomes for our patient population. When our patients stay healthier while on dialysis, they will improve their chances of being a strong candidate for transplantation. Our proven success to improve patient outcomes and lower costs through value-based care models under the CMS supports expanding these efforts to many more patients.
We agree with the American Society of Transplantation that improving access to transplantation and increasing organ availability is critical to the health of all patients with chronic kidney disease. That is why our Fresenius Medical Care Foundation, launched in April, has made transplant and donor awareness a top priority.
There is broad bipartisan support for the PATIENTS Act from 181 co-sponsors in Congress, demonstrating a strong desire among legislators to transform care for our patient population. We hope that the American Society of Transplantation will consider joining this effort to improve the lives of patients with kidney failure by moving us further toward proven value-based care solutions.
- For more information:
- Franklin W. Maddux, MD, FACP, is executive vice president for clinical and scientific affairs and chief medical officer of Fresenius Medical Care North America.