Policy and Politics News

Researchers from the Dialysis Outcomes and Practice Patterns Study (DOPPS) released a fresh batch of data­­––through April of this year––from its Practice Monitor yesterday, showing that while adequacy and hemoglobins have stabilized, ferritin levels may be a cause for concern.

Lawyers representing DaVita in a whistleblower case accusing the provider of overcharging Medicare for dialysis drugs are awaiting a federal judge’s ruling on the impact of falsified testimony provided by DaVita employees on the role of the company’s internal software system’s in suggesting a prescribed amount for the drugs.

The five-star rating system in health care was the brainchild of  Oregon Senator Ron Wyden, D-Oregon, who said during a congressional hearing in 2007 that shopping for washing machines was easier than selecting a nursing home. Medicare officials took his cue and set up a five-star rating system in 2009, a move that was applauded by consumer groups, who hoped that more transparency would lead to greater accountability.

Even with a second round of "fixes" to the original proposal to launch a demonstration testing the accountable care model in renal care, large dialysis providers who have submitted applications still are unclear on how Medicare expects the project to unfold in January.

Many renal organizations have asked the Centers for Medicare & Medicaid Services to delay implementation of its new 5-star rating system, which is scheduled to go live on Dialysis Facility Compare in October. Below are letters voicing concern about the new program, and its potential impact on dialysis patients.

The Medicare Payment Advisory Commission has recommended that the Centers for Medicare & Medicaid Services delay implementation of its five star rating system for dialysis facilities, which is scheduled to go live on Dialysis Facility Compare in October. "We urge that CMS delay the implementation of the Dialysis Star Ratings System in order for the agency to issue a proposal to establish the system," the Chairman of MedPac Glenn M. Hackbarth, JD, said in a letter to CMS administrator Marilyn Tavenner. "In its proposal, CMS should describe why the agency believes a second quality measurement system for dialysis facilities—beyond the current QIP—is needed and address the comments they receive." The letters says MedPAC is concerned "that CMS intends to establish the Dialysis Star Ratings System beginning October 2014 without addressing public comments." MedPAC also expressed concern that the program's scoring methods and measures differ from the methods used in the ESRD Quality Incentive Program, and "might result in a facility scoring high under one program and low under the other program. Beneficiaries and their families might be confused if a facility’s star and QIP scores diverge." "Moving to two systems creates greater uncertainty" Hackbarth wrote in the letter. "The Commission generally believes that the measurement of quality performance should be based on absolute standards rather than one calculated from the performance distribution. We believe this is fairer to providers and gives clearer targets for providers to meet. If CMS can establish the need for a Star Ratings System for dialysis facilities, the agency should then describe why it believes the measures in the QIP are an insufficient basis for establishing a Star Ratings Systems. The proposal will also give CMS an opportunity to provide an analysis of the correlation between the ratings calculated under the Dialysis Star Ratings System and the ESRD QIP and explain any discrepancies in measured facility performance between the two measures." The MedPAC letter also includes comments on the proposed rule released July 2 that would update payment policies and rates under the End-Stage Renal Disease Prospective Payment System and proposes changes to the ESRD Quality Incentive Program for payment year 2017 and PY 2018.

After almost 12 years on dialysis, I am ready to have a functioning kidney so I can have a more normal life.

Chronic hemodialysis in Seattle developed with a highly patient-centric approach, providing patients the option of dialyzing in neighborhood units under the administration of a non-profit organization, the Northwest Kidney Center (NKC). This study examined the effects of a requirement in the 2009 Conditions for Coverage that in-center hemodialysis patients be visited quarterly during their treatment session. A retrospective analysis of quality outcome indicators for patients managed at the University of Washington Medical Center and dialyzing at NKC in 2008 and 2010 found that dialysis adequacy (eKt/V), phosphorus, albumin, and hemoglobin were not improved by quarterly dialysis visits. Instead, dialysis unit visits adversely impacted patient-nephrologist relationships and diverted nephrologists from other patient care activities.

Kidney Care Partners, a coalition of patient advocates, clinicians, care professionals, dialysis providers, researchers and manufacturers, is calling on the Centers for Medicare & Medicaid Services to delay implementation of the five-star rating system and work with the community to provide useful, meaningful, and accurate ratings of dialysis providers. KCP said it is concerned that the rating system, which is scheduled to go live on Dialysis Facility Compare in October, will confuse and mislead dialysis patients.

The renal community has several approaching deadlines on proposed rules and various CMS-directed clinic reviews.