Policy and Politics News

Last month, a ProPublica interview with a nephrology nurse who was critical of what she called dialysis patients' "sense of entitlement" struck a nerve with our readers. Dialysis patients and nurses took to our comment section, and social media, to express their opinions.

When Congress passed legislation in 1972 authorizing Medicare to establish and fund the End-Stage Renal Disease Program, it miscalculated on both the eventual census (assumed about 35,000 prevalent patients each year) and the cost of the program (about $1 billion a year). That’s not unusual for government regulators. But the legislators got one other thing wrong: that most individuals, once saved by dialysis, would retain their place in the work force.

In a paper published in NN&I last month by Provenzano et al., the authors said they struggled to reach a target sample size for their study, particularly in finding a control group of patients with catheters. "Several clinic policy changes...targeted reduction of catheter access which in turn reduced the number of eligible patients. The Fistula First initiative was implemented prior to study initiation...Directly following this, a dialysis provider initiative targeting central catheter rates was also introduced; this policy required central catheter target rates of less than or equal to 13% in each dialysis facility.."

Physicians, where art thou?

The ability to measure and report on the quality of care nephrologists provide is increasingly important. The physician quality reporting system (PQRS), the value-based modifier (VBM), and the soon-to-be enacted merit-based incentive payment system (MIPS) are now, or will shortly, impact the fee-for-service revenue of nephrology practices. When combined with the alternative payment models and the various government programs publicly reporting both provider quality and other financial data, it is clear that generating relative value units (RVUs) and having reason­ ably satisfied patients is no longer enough to be considered a successful nephrologist.

The former owner, billing manager, and supervisor of a Southern California ambulance company were sentenced to prison for their roles in a fraud scheme that resulted in more than $1.5 million in fraudulent claims to Medicare. The defendants had conspired to bill Medicare for ambulance transportation services for individuals that did not need such services, many of whom were dialysis patients.

The next generation of care is here. How will it impact the practice of nephrology and the provision of dialysis services? Genomics, point-of-care diagnostics, big data, open sourcing, and smartphones will empower patients to disrupt the paternalistic model of nephrology and dialysis. This disruption has a name. It is called the “democratization of medicine.”1

A Nov. 20 article written by ProPublica journalist Alec MacGillis attempts to explain why economically depressed regions of the United States that rely on Democrat supported safety-net programs are voting increasingly for Republicans who are opposed to the programs. The article was featured in the New York Times.

Health care spending in the United States grew at a rate of 5.3% to $3 trillion, or $9,523 per person, according to a new analysis from the Office of the Actuary at the Centers for Medicare & Medicaid Services. The growth in health spending was primarily driven by coverage expansions under the Affordable Care Act (ACA), particularly for private health insurance and Medicaid, as well as by rapid growth in spending on retail prescription drugs, fueled in part by new drug treatments for hepatitis C, according to the report. The previous five years saw historically low growth, which averaged 3.7%. In 2013, growth was 2.9%.

The United States District Court for the Northern District of Georgia has ruled that Fresenius Medical Care did not violate the False Claims Act by billing Medicare for the overfill in medication vials, the National Law Review reported.