ESRD reform still on table with Grassley legislation

WASHINGTON--It’s of little surprise that Senate Republicans and Democrats are dueling on Medicare reform in advance of a 10.6 percent physician fee cut, but in a rare form of agreement, both sides of the aisle have proposed nearly identical changes to the End-Stage Renal Disease Program.

Both parties want to avoid the looming Medicare physician fee cut, which goes into effect July 1, but the main point of contention is how to pay for it.

Earlier this month, Senate Finance Committee Chairman Max Baucus, D-Mont., proposed legislation that included heavy cuts to Medicare Advantage plans, which give Medicare beneficiaries the option to receive benefits through private plans.

Click HERE to read about Baucus’ legislation.

But on June 11, Sen. Chuck Grassley, R-Iowa, released rival legislation—called the Preserving Access to Medicare Act of 2008—that does not cut the private plans as much as Baucus’ bill. However, the two bills have very similar ideas in how to reform the ESRD Program—including an annual update, bundled payments and quality incentives.

President Bush, however, threatened to veto Baucus’ bill due to its sharper Medicare Advantage cuts, and the Senate eventually blocked consideration of his bill on June 12 by a vote of 54-39. Grassley has said Baucus’ failed bill could pave the way for more effective negotiations in the coming weeks.

Grassley’s ESRD proposals, an echo of Baucus’ provisions, are summarized below.

CKD Awareness and Prevention

Grassley’s bill calls on the federal government to increase awareness and prevention of chronic kidney disease by increasing CKD screening for Medicare beneficiaries and to “enhance surveillance systems to better assess the prevalence and incidence” of CKD.

These provisions will start as a pilot program in three states for five years, starting no later than Jan. 1, 2009, according to the bill.

The bill also calls for Medicare to pay for kidney disease education for CKD stage 4 patients. The program would start by Jan. 1, 2010, and patients would receive no more than six education sessions, which would be designed to include the following provisions.

• The management of comorbidities in order to delay the need for dialysis
• Prevention of uremic complications
• Provide information on therapy options, including hemodialysis and peritoneal dialysis at home and in-center, as well as vascular access and transplantation
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