Policy and Politics News

A bill has been introduced in the Senate that would give dialysis clinics the option to seek certification from an approved third party. Senators Pat Roberts, R-Kansas, Mark Warner,D-Va, Mike Crapo, R-Idaho, Ben Cardin, D-Md., and Todd Young, R-Ind., introduced S. 1729, the Dialysis Access Improvement Act, on Aug. 3.

We often look to medical research to enhance the quality of life and survival of dialysis patients. But in striving toward those goals we must not ignore the role that financial incentives—or disincentives—play in the major for-profit industry that dialysis care has become. The principal revenue source for this industry in the United States is Medicare. How Medicare structures its payment rules matters.1

The Medicare Part B Improvement Act, HR 3178, has passed the House of Representatives. The bill includes a measure to give dialysis clinics the option to seek certification from an approved third party, and a measure to allow dialysis facilities and the home to be approved telemedicine originating sites for home dialysis.

We have been practicing as kidney doctors for 15 years in Sun Valley, California, a city on the outskirts of Los Angeles. We opened Laurel Canyon Dialysis, a dialysis facility in the heart of Sun Valley, about two years ago and currently serve around 200 patients.

Concerns that the codes used to determine payment for home dialysis patients would be revised were alleviated when the Centers for Medicare & Medicaid Services released the 2018 Medicare Physician Fee Schedule on July 13.

A bill that has passed the House Ways and Means Committee would give dialysis clinics the option to seek certification from an approved third party.

The Centers for Medicare & Medicaid Services will hold a listening session on the proposed rule for payment year 2021 on Wednesday, July 26 from 2 to 3 pm ET. (Register here)

Update: Earlier this month, the Senate threw in the towel on health care reform after more Republican party defectors killed any chance of passing the Better Care Reconciliation Act, the Senate’s plan to replace the Affordable Care Act. Part of the loss in party support came from legislators who worried that planned Medicaid cuts would leave millions of U.S. citizens without insurance.

Legislation that would mandate staff to patient ratios in California dialysis clinics has been amended to include the option for the State Department of Public Health to grant a waiver to dialysis clinics in rural counties, defined as having a population of less than 250,000 with no single urbanized area with a population of greater than 50,000.

Legislators in California, where a universal, one-payer health care system is now under consideration, are pushing a bill that would require major dialysis chains in the state to rebate excessive revenue each year to payers.