A New Push for Home Dialysis Funding in Washington

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Rep. Charles Bass, R-N.H

Legislation was proposed in May that would look to Medicare to create a pilot program to test whether home dialysis could deliver the cost savings and increased quality of life that so many proponents of the modality have been touting for the last several years.

“As the dialysis population increases, there needs to be new breakthroughs in palliative technology,” says Rep. Charles Bass, R-N.H. “Now is the time to start doing that.”

In May, Bass introduced the Access to Better Choice in Dialysis Act of 2006, which would establish a five-year pilot program that reimburses up to seven dialysis treatments per week. Data collected by the program would measure the financial impact of more frequent dialysis.

According to the proposed legislation, the first three home dialysis treatments each week would be reimbursed at the standard composite rate, which is approximately $128 per treatment. However, each subsequent treatment in the week would be reimbursed at a decreasing percentage of the full composite rate.

  • The fourth session would be reimbursed at 70 percent
  • The fifth session would be reimbursed at 40 percent
  • The sixth session would be reimbursed at 30 percent
  • The seventh session would be reimbursed at 20 percent

There would be a cap on the amount of money Medicare could spend on the demonstration project each year. The limit would be $15 million the first year, $30 million in the second year, $50 million in the third year, $75 million in the fourth year, and $90 million in the fifth year. There would be no more funding for the extra sessions after the fifth year.

The bill’s $260 million total is small relative to the amount Medicare spends annually, which can exceed $300 billion. “Many policymakers have expressed interest in the legislation, and we have yet to meet with direct opposition,” says Jodie Low, director of government affairs & policy at Kimbell & Associates, a healthcare lobbying firm. “Compared to other legislative proposals that would modify the ESRD program, this pilot program is relatively inexpensive.”

The obvious question remains though: Does this bill have a chance of passing?

Regardless of the bill’s price tag, the legislation will likely still need to latch onto a larger Medicare bill in order to get through Congress. The chances are slim that will happen as the number of legislative days dwindle in a busy election year. “It’s unlikely it would pass on its own,” Bass says.

Perhaps more problematic to supporters is that members of Congress, and many patients, remain unaware of the modality. In a recent survey, 88 percent of dialysis patients said they were uninformed about home hemodialysis.

“This is perfect for a grassroots campaign,” says Joe Turk, NxStage senior vice president, commercial operations. “Many patients are not aware.”

Turk is the president of the Coalition for Dialysis Patient Choice, the driving force behind the bill. Its membership includes NxStage, Aksys and Renal Solutions—all major players in the fledgling home dialysis industry. “The objective is to think through something as a coalition,” Turk adds.

More important to the Coalition is generating support among a skeptical dialysis community. In a June press release, dialysis provider DaVita said it does not expect Congress to pass anything to pay for more frequent dialysis in the next few years.

DaVita added that home dialysis without additional reimbursement generates losses significantly greater than those of Medicare patients taken care of within a center.

The current home dialysis legislation, HR 5321, has two co-sponsors: Rep. Sam Johnson, R-Tex., and Rep. Jim McDermott, D-Wash. McDermott is an important ally in getting the bill passed. He is the co-chair of the Congressional Kidney Caucus.

The bi-partisan caucus was formed with the intent to increase awareness in Congress. According to its Web site, the caucus currently has 67 congressional members. The Caucus does not officially endorse the legislation, but has been active in working with the Coalition and the National Kidney Foundation in educating congressional staff on home dialysis modalities.

As evident by the formation of the Coalition, home dialysis advocates are becoming more centralized in refining their message. Even if the bill doesn’t pass this year, it represents a growing momentum of support for home dialysis. Last year, McDermott introduced the Kidney Patient More Frequent Dialysis Quality Act of 2005. But unlike this year’s bill, the 2005 version did not lay out a direct spending plan.

“This bill [HR 5321] is more specific,” Turk says. “It is more of a demonstration project so policy makers will know there is an end in mind.”

The biggest knock against implementing home dialysis is that its cost-saving benefits are untested on a large scale. Supporters hope this legislation can pave the way to get real data about the positive effects of home dialysis. “We won’t know if we don’t try,” Bass says.

Under the proposal, Medicare would study the overall health of the patient and the use of other separately billable drugs— such as erythropoietin and iron—and hospitalizations.

The government would also look into patients’ working status by analyzing Social Security Disability Insurance payments and state tax payments, and the impact on Medicare payments due to coverage under employer health group plans.

Supporters of HR 5321 say they hope to get a majority of last year’s 42 cosponsors on board for this year’s version. “It’s a question of educating Congress,” Bass says. “This is the second year and if it’s not successful, we will continue to work on it.”

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