Baucus unveils legislation with significant ESRD reform

GAO follow-up

In order to allay some concerns over the consequences of a bundled payment, Baucus’ legislation would call on the government to follow up with a detailed report by 2013.

The Government Accountability Office would be required to submit a report that tracks changes in ESRD care as a result of the bundled system. The bill specifically calls on the GAO to report changes in ESA use and the differences in giving them intravenously or subcutaneously, a payment analysis that includes the affects on rural and low-volume providers, changes in other drug use, and any recommendation for changes that might need to be made.

Education and Awareness Provisions

The Baucus bill also targets kidney disease education awareness in an effort to curb the progression of chronic kidney disease patients to dialysis. Specifically, the bill wants to “increase public and medical community awareness (particularly of those who treat patients with diabetes and hypertension) regarding chronic kidney disease, focusing on prevention.”

The bill calls for an increase in CKD screening of Medicare beneficiaries at risk for CKD. It also looks to enhance surveillance systems to better track the rise of CKD.

Three states would be chosen to start five-year pilot programs starting in 2009 to evaluate education and awareness programs.

In addition, CKD stage 4 patients would be eligible for Medicare-covered education services that would teach them how to manage their comorbidities and prevent uremic complications. It would also teach them about their treatment options, including hemodialysis, peritoneal dialysis, home dialysis, vascular access options and transplantation.