Policy and Politics News

NN&I asked Donna Bednarski, RN, MSN, ANP-BC, CNN, Kidney Care Partners consultant for the American Nephrology Nurses Association (ANNA), and Robert Blaser, director of public policy for the Renal Physicians Association (RPA), for their thoughts on what the next 12 months could look like on Capitol Hill for the kidney care community. In Part 1, published in the January issue of NN&I (available at www.nephrologynews.com), our policy experts covered the ongoing vacancy at HHS and the rising interest in regulating staff-patient ratios in dialysis clinics. This month, Part 2 continues with a look at physician payment, acute kidney injury (AKI) and outpatient care, and concerns about restricting the use of more frequent dialysis.

A proposal to implement a shared savings model for nephrologists’ reimbursement during the initial 6 months of dialysis care has won approval from a government advisory committee and is under review by CMS for possible implementation.

Last fall, seven of the 10 Medicare Administrative Contractors proposed revisions to their payment policies that would restrict the use of more frequent dialysis. This can be defined as any form of hemodialysis beyond the standard three times a week, such as short daily dialysis or nocturnal dialysis every other day. While the MACs have defined payment codes that allow exceptions for patients who need more dialysis on a temporary basis, the revisions would eliminate these modality options for patients who want better care.

Kidney Care Partners, a kidney coalition comprised of physician groups, providers, patient advocacy groups, manufacturers and researchers, has shown support for the U.S. Senate and House approval of Alex Azar as the new HHS Secretary.

The FDA is working with Baxter Healthcare, B. Braun and other manufacturers to find ways to alleviate the shortage of IV saline, which is used by dialysis clinics and other health care providers.

A proposal to implement a shared savings model for nephrologists’ reimbursement during the initial 6 months of dialysis care has won approval from a government advisory committee and is under review by CMS for possible implementation.

Looking over the important events that shaped renal care in 2017 – clinical developments, policy changes, testing new payment models and natural disasters that challenged patients and providers – it becomes clear that few of these have been wrapped up in a neat, tidy bow. Many have already make tracks for 2018.

The Renal Physicians Association has long held the position that nephrologists are the leaders of the kidney care team. However, many practitioners do not possess essential skills or formal training required to be successful leaders.

Medicare administrative contractors are responsible for reviewing claims from health care providers, including dialysis companies, and paying Medicare rates for provided patient services. Seven of these MACs simultaneously released proposed LCDs, or payment policy rules, last September on how these contractors would cover more frequent hemodialysis, defined as beyond the standard three times per week covered in the bundled payment rate.

Nov. 1, 2017 was a key date for nephrologists and the general physician community. The 2018 Medicare Quality Payment Program was released. The news was mixed for nephrologists who hoped to escape Medicare’s regulatory reach on how they practice medicine. Here are some of the details.