Policy and Politics News

In a letter to the Centers for Medicare & Medicaid Services' Center for Clinical Standards and Quality, Dialysis Patient Citizens expressed concern about the implementation of Dialysis Facility Compare's new five-star rating system.

U.S. House Representatives Tom Marino (R-Pa.) and John Lewis (D-Ga.) have introduced “The Chronic Kidney Disease Improvement in Research and Treatment Act” (H.R. 4814), a bill that supports improvements in the research, treatment, and care of chronic kidney disease.

The National Kidney Foundation said it supports the Living Donor Protection Act of 2014, introduced July 30 by Representative Jerrold Nadler, D-N.Y., along with Representative Michael Burgess, MD, R-Texas, to promote organ donation and protect the rights of living donors.

The Centers for Medicare & Medicaid Services has released the preliminary End-Stage Renal Disease Quality Incentive Program performance scores and penalties for dialysis clinics based on how they provided care to patients last year. Dialysis providers have until Aug. 15 to contest the results.

The American Kidney Fund has announced its support for the Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 4814), which would aim to improve the health of Americans who are living with, or at risk for, chronic kidney disease and kidney failure.

Last month in NN&I, we presented the case study of Western Maryland Regional Health System in Cumberland, Md., which opened a new, 275-bed comprehensive regional referral center in 2010 with a 12,722 sq. ft., 35-station outpatient dialysis facility. In 2011, WMHS entered an agreement with the Maryland Health Services Cost Review Commission to adopt the Total Patient Revenue System, which provides hospitals with a financial incentive to manage their resources efficiently and effectively in order to slow the rate of increasing health care costs. The basic concept embodied in the TPR constraint system is the assurance of a certain amount of revenue each year, independent of the number of patients treated and the amount of services provided to these patients. The hospital therefore has the incentive to reduce length of stay, ancillary testing, and unnecessary admissions and readmissions.

The end-stage renal disease program has led American health care quality measurement by utilizing robust and transparent metrics. Using this data to drive change, there have been year over year improvements in intermediary outcomes and resultant reduced mortality over time for the ESRD population.

Can you remember back to 1992? That was the year that Bill Clinton became president of the United States, the movie Basic Instinct was released, the Mall of America in Minnesota was built, and the cost of a gallon of gasoline was $1.05.  In the medical field, DNA fingerprinting was invented, and in the end-stage renal disease community, there were 220,000 patients, with 22,000 waiting for a kidney transplant. The average public and private insurance annual expense per dialysis patient was $47,000. Epogen, which was approved by the U.S. Food and Drug Administration in 1989, was being used by 82% of all hemodialysis patients, and the average hematocrit was 29.6 % (USRDS, 1993). In 1992, many states also had kidney programs that assisted ESRD consumers with expenses related to their treatment. Some also provided patients with resources related to education, prevention, and funded or conducted research related to kidney disease. In March of that year, this journal published an article entitled, “State kidney programs: Will they survive?” 1 The authors, from the National Organization for State Kidney Programs, compared funding levels with caseloads of state programs between 1980 and 1990 and found that while funding levels had stayed flat, caseloads had increased significantly. Of the 22 state kidney programs who responded to their 1991 survey, most programs indicated they had to take assertive steps to tighten their eligibility requirements and reduce or eliminate some services. In fact, the authors’ prediction in the NN&I article was spot on: “…State kidney programs will be challenged throughout the remainder of the decade and beyond. Without aggressive and innovative cost-containment efforts, state kidney programs are likely to face even more difficult times ahead.” Today, the overall number of state kidney programs is decreasing, and the services offered have been drastically reduced. During the past 5-7 years, many states have cut back on funding vital services for health and education programs. Consequently state kidney programs have been affected. In addition, ESRD no longer holds the public interest or creates the outcry of needs. Other medical issues seem to have a higher priority (in Missouri, the only state health initiative to gain funding recently was autism).

It seems like the renal community is going through an endless tunnel of change. It’s not clear if regulators and Congress decided to define this particular decade as one of change for publicly funded health care, but it certainly has been like one of those bucking bull rides you might see in a Texas country bar. And it’s not clear when the ride will end.

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