Alonzo Mourning: Don’t cut funding for dialysis - Other Views - MiamiHerald.com
ACT NOW: https://www.change.org/petitions/center-for-medicaid-and-medicare-services-cms-withdraw-the-proposed-cuts-to-dialysis-centers-and-esrd-patients
Tuesday, July 30, 2013
Bennie Thompson Aims to Stop Proposed Cuts to Dialysis Providers | MPB News
Thursday, July 25, 2013
KIDNEY STORIES: MORE ON CMS CUTS BY DEVON TEXAS
FROM DEVON TEXAS:
For the last several days, I’ve been posting about the Medicare/CMS cuts to providers payments for dialysis treatments. (“Dialysis and Action” and “Dialysis and Action (More)” and “Dialysis and Further Action“) Well, her...e’s more. I don’t want to bore you about this but it’s really quite important. I’d like to fill you in on the cuts and what they mean to us.
In every forum and group I’ve been involved with this week, this have been a topic of discussion. It’s that important. We’re all very concerned about it, not because it’s cuts to provider payments but that it will surely filter down to cuts at the patient level. For the large providers, it means less than to smaller, independent providers. Then, finally, we will be the ones most hurt by these cuts.
Some History
From the Wall Street Journal:
Based on government reports, Medicare for years has overpaid for the anti-anemia drugs used in the treatment of kidney dialysis patients. One recent estimate said Medicare paid $529 million more than it should have in 2011 for the drugs made by Amgen Inc. (AMGN) and others.
As a result, lawmakers have tried to rein in the costs of those drugs. In 2011, the drugs were included in the “bundle” payment given to dialysis centers, a lump sum that includes the costs for all dialysis services.
In addition, CMS was expected to propose a new payment rate by this summer that will go into effect next year. The reductions are projected to save Medicare $4.9 billion over 10 years, according to the Congressional Budget Office.”
So Medicare/CMS is not the “bad guy” in this case. They are simply doing what Congress told them to do in the ATRA2012. It’s not like they would put themselves into this hotseat on purpose!
The Proposal
So, here’s a careful review of the proposed cuts from the CMS along with my thoughts about them. First, here’s the actual text of the section in the CMS proposal having to do with the cut to provider payments. I highlighted the pertinent parts of the paragraph as shown below…
——————————————————————————————————-
IV. CALCULATION OF THE AMOUNT OF THE PER TREATMENT REDUCTION
We applied the 2014 prices to the CY 2007 and CY 2012 drug and biological utilization data to calculate aggregate amounts for each year. For drugs and biologicals for which we have utilization data for CY 2012, but that were not present on CY 2007 claims, we priced these drugs using the ASP+6 percent price for 2012, which is an average of the four quarter prices, and inflated it using the CY 2013 and the CY 2014 proposed ESRDB market basket, productivity, and wage index budget neutrality adjustment factors. While most of these drugs had minimal utilization, we note that Feraheme was the only significant exception. Specifically, Feraheme was not available until January 2010 and once the drug was available, the use of the drug rose to the top 12th drug furnished to ESRD beneficiaries. Next, we divided each year’s estimated aggregate amount for drugs and biologicals by that year’s count of treatments furnished to Medicare beneficiaries to get an average payment per treatment for the year. This resulted in a per treatment amount for drugs and biologicals of $83.76 in 2007 and a per treatment amount for drugs and biologicals of $51.42 in 2012. We then subtracted the average payment per treatment for CY 2012 from the average amount per treatment for CY 2007 to get a total of $32.34 ($83.76−$51.42 = $32.34). We then reduced this amount by the standardization, the outlier, and the 98 percent budget neutrality adjustments to get a total of $29.52 ($32.34 × .9407 × .99 × .98 = $29.52). We would apply these adjustments before reducing the base rate because the base rate was reduced by these adjustments when it was first established, and the reduction should be adjusted in the same way to make the two figures comparable. We would then reduce the CY 2014 proposed base rate of $246.47 by $29.52, resulting in the CY 2014 proposed base rate of $216.95. A reduction of $29.52 from the proposed CY 2014 ESRD PPS base rate results in a 12 percent reduction in Medicare payments. We solicit comments on the proposed methodology for the reduction to the ESRD PPS base rate to reflect the change in the utilization of ESRD-related drugs and biologicals from CY 2007 to CY 2012.While we propose to implement the full reduction in CY 2014, we note that we are also concerned that this one-time reduction to the ESRD PPS base rate could be a significant reduction to ESRD facilities for the year and potentially impact beneficiary access to care. Therefore, we are soliciting comments on a potential transition or phase-in period of the 12 percent reduction and the number of years for such transition or phase-in period.
——————————————————————————————————
It’s interesting that they note this is a drastic reduction but they do open the door to suggestions for a “transition or phase-in period for the 12 percent reduction”.
It concerns me that they are using the 2007 rates for dialysis and essentially rolling back their payment rate to the 2007 rate. “We then subtracted the average payment per treatment for CY 2012 from the average amount per treatment for CY 2007 to get a total of $32.34 ($83.76−$51.42 = $32.34)”. That’s how they get this ridiculous rate!
I spoke with a very knowledgeable source about the cuts and he explained that part of the sense behind this roll-back to 2007 was because Medicare felt they had been overpaying the providers since then because of the “bundling” of payments over the last couple years. This cut, in their minds, was to level the payment field. Since they had increased total payment to include things other than just dialysis, they were due for a cut to reflect the savings from “bundling”.
I suggest we continue to protest the total reduction but be prepared to comment with a suggestion for a phase-in or transition for the reduction… say, 5 years (about the middle of August (before the 8/30/13 deadline). However, a CPI adjustment should also factor into the calculation. In fact, I’m concerned there is no factor in their calculation for increases in the Consumer Price Index or other provider cost increases over that SIX YEAR period from 2007 to 2013! That should just about cover the “bundling” savings CMS wants to use as the basis for this cut.
https://www.change.org/petitions/center-for-medicaid-and-medicare-services-cms-withdraw-the-proposed-cuts-to-dialysis-centers-and-esrd-patients
For the last several days, I’ve been posting about the Medicare/CMS cuts to providers payments for dialysis treatments. (“Dialysis and Action” and “Dialysis and Action (More)” and “Dialysis and Further Action“) Well, her...e’s more. I don’t want to bore you about this but it’s really quite important. I’d like to fill you in on the cuts and what they mean to us.
In every forum and group I’ve been involved with this week, this have been a topic of discussion. It’s that important. We’re all very concerned about it, not because it’s cuts to provider payments but that it will surely filter down to cuts at the patient level. For the large providers, it means less than to smaller, independent providers. Then, finally, we will be the ones most hurt by these cuts.
Some History
From the Wall Street Journal:
Based on government reports, Medicare for years has overpaid for the anti-anemia drugs used in the treatment of kidney dialysis patients. One recent estimate said Medicare paid $529 million more than it should have in 2011 for the drugs made by Amgen Inc. (AMGN) and others.
As a result, lawmakers have tried to rein in the costs of those drugs. In 2011, the drugs were included in the “bundle” payment given to dialysis centers, a lump sum that includes the costs for all dialysis services.
In addition, CMS was expected to propose a new payment rate by this summer that will go into effect next year. The reductions are projected to save Medicare $4.9 billion over 10 years, according to the Congressional Budget Office.”
So Medicare/CMS is not the “bad guy” in this case. They are simply doing what Congress told them to do in the ATRA2012. It’s not like they would put themselves into this hotseat on purpose!
The Proposal
So, here’s a careful review of the proposed cuts from the CMS along with my thoughts about them. First, here’s the actual text of the section in the CMS proposal having to do with the cut to provider payments. I highlighted the pertinent parts of the paragraph as shown below…
——————————————————————————————————-
IV. CALCULATION OF THE AMOUNT OF THE PER TREATMENT REDUCTION
We applied the 2014 prices to the CY 2007 and CY 2012 drug and biological utilization data to calculate aggregate amounts for each year. For drugs and biologicals for which we have utilization data for CY 2012, but that were not present on CY 2007 claims, we priced these drugs using the ASP+6 percent price for 2012, which is an average of the four quarter prices, and inflated it using the CY 2013 and the CY 2014 proposed ESRDB market basket, productivity, and wage index budget neutrality adjustment factors. While most of these drugs had minimal utilization, we note that Feraheme was the only significant exception. Specifically, Feraheme was not available until January 2010 and once the drug was available, the use of the drug rose to the top 12th drug furnished to ESRD beneficiaries. Next, we divided each year’s estimated aggregate amount for drugs and biologicals by that year’s count of treatments furnished to Medicare beneficiaries to get an average payment per treatment for the year. This resulted in a per treatment amount for drugs and biologicals of $83.76 in 2007 and a per treatment amount for drugs and biologicals of $51.42 in 2012. We then subtracted the average payment per treatment for CY 2012 from the average amount per treatment for CY 2007 to get a total of $32.34 ($83.76−$51.42 = $32.34). We then reduced this amount by the standardization, the outlier, and the 98 percent budget neutrality adjustments to get a total of $29.52 ($32.34 × .9407 × .99 × .98 = $29.52). We would apply these adjustments before reducing the base rate because the base rate was reduced by these adjustments when it was first established, and the reduction should be adjusted in the same way to make the two figures comparable. We would then reduce the CY 2014 proposed base rate of $246.47 by $29.52, resulting in the CY 2014 proposed base rate of $216.95. A reduction of $29.52 from the proposed CY 2014 ESRD PPS base rate results in a 12 percent reduction in Medicare payments. We solicit comments on the proposed methodology for the reduction to the ESRD PPS base rate to reflect the change in the utilization of ESRD-related drugs and biologicals from CY 2007 to CY 2012.While we propose to implement the full reduction in CY 2014, we note that we are also concerned that this one-time reduction to the ESRD PPS base rate could be a significant reduction to ESRD facilities for the year and potentially impact beneficiary access to care. Therefore, we are soliciting comments on a potential transition or phase-in period of the 12 percent reduction and the number of years for such transition or phase-in period.
——————————————————————————————————
It’s interesting that they note this is a drastic reduction but they do open the door to suggestions for a “transition or phase-in period for the 12 percent reduction”.
It concerns me that they are using the 2007 rates for dialysis and essentially rolling back their payment rate to the 2007 rate. “We then subtracted the average payment per treatment for CY 2012 from the average amount per treatment for CY 2007 to get a total of $32.34 ($83.76−$51.42 = $32.34)”. That’s how they get this ridiculous rate!
I spoke with a very knowledgeable source about the cuts and he explained that part of the sense behind this roll-back to 2007 was because Medicare felt they had been overpaying the providers since then because of the “bundling” of payments over the last couple years. This cut, in their minds, was to level the payment field. Since they had increased total payment to include things other than just dialysis, they were due for a cut to reflect the savings from “bundling”.
I suggest we continue to protest the total reduction but be prepared to comment with a suggestion for a phase-in or transition for the reduction… say, 5 years (about the middle of August (before the 8/30/13 deadline). However, a CPI adjustment should also factor into the calculation. In fact, I’m concerned there is no factor in their calculation for increases in the Consumer Price Index or other provider cost increases over that SIX YEAR period from 2007 to 2013! That should just about cover the “bundling” savings CMS wants to use as the basis for this cut.
https://www.change.org/petitions/center-for-medicaid-and-medicare-services-cms-withdraw-the-proposed-cuts-to-dialysis-centers-and-esrd-patients
Wednesday, July 24, 2013
Monday, July 22, 2013
KIDNEY STORIES: DO THE NEW CUTS AFFECT HOME DIALYSIS?
DOES THE PROPOSED CUTS FROM CMS TO DIALYSIS IN PATIENT CENTERS AFFECT HOME HEMO AND PERITONEAL PATIENTS?
As many of you know, I have been advocating against the proposed cuts to Medicare payments to dialysis centers and in turn the affect this has in all in center patients, including both Medicare patients as well as private insurance patients. Obviously a reduction in payments to centers could result in a cutting of services, a layoff of valuable dialysis employees like techs, nurses and social workers, the possible closing of centers, and the shuffling and relocation of dialysis patients to different centers. There has also been expressed that dialysis on demand may be in jeopardy as a possible return to dialysis by committee selection. Most of my in center dialysis friends have gotten the message and are taking steps to make their objections known. Where some resistance in the dialysis community remains is with people that take dialysis at home, either home hemo or peritoneal dialysis.
The general remark that is made is that since the cuts do not affect home dialysis patients, this is not our fight. I wrote the Dialysis Patient Citizens asking if these cuts affect home dialysis patients and here is the response I received:
“STATEMENT FROM THE ALLIANCE FOR HOME DIALYSIS:
December 3, 2012
Dear Member of Congress:
As you consider solutions to address the economic challenges facing the country, the Alliance for Home Dialysis urges you to protect Medicare beneficiaries’ access to home dialysis by refraining from making any additional payment reductions to the Medicare End Stage Renal Disease (ESRD) Prospective Payment for dialysis.
The Alliance for Home Dialysis is a coalition of kidney dialysis stakeholders, representing patients, clinicians, providers and industry, that have come together to promote activities and policies that will facilitate treatment choice in dialysis care while addressing systematic barriers that limit access for patients and their families to the many benefits of home dialysis. Congress has long recognized the importance of ensuring beneficiaries have access to a choice of modalities, which include peritoneal dialysis (PD) and home hemodialysis (HHD), because they offer some patients significant quality of life advantages, including clinically meaningful improvements in physical and mental health.
The Alliance is concerned that reductions to the ESRD Prospective Payment System (PPS) could jeopardize Medicare beneficiaries’ access to home dialysis. (Emphasis added). The implementation of the new ESRD bundled payment—the first value-based purchasing program under Medicare—has been successful in making progress towards one of its stated goals i.e., to “encourage patient access to home dialysis” 1 and to “make home dialysis economically feasible and available to the ESRD patient population.” 2 Today, only about 10% of U.S. dialysis patients receive treatment at home. Yet, the most recent annual survey of the ten largest providers found that between 2010-2012 home patients represented about 20% of the growth in ESRD patients. This is significant given that in years prior there had been little growth in home dialysis.
We are concerned that payment reductions risk reversing the progress that has been made toward increasing access to home dialysis, as facilities may not be able to invest in the development and ongoing management of home dialysis programs . Dialysis facilities were already subject to a two percent payment reduction under the new bundled payment and are facing a two percent cut through sequestration next year. Because nearly 80% of dialysis patients are Medicare beneficiaries, facilities do not have the same ability to spread costs to other payers as broadly as other Medicare providers. Most importantly, the ESRD PPS system is still in its infancy, with full implementation not taking effect until 2014. More experience with the system is necessary to understand the full impact of the program before any fundamental changes are made. (Emphasis added).
1 75 Fed. Reg. 49,030, 49,058 (Aug. 12, 2010). 2 Id . at 49,060.
Congress should maintain its commitment to the approximately 400,000 Americans on kidney dialysis by preserving current payment rates and ensuring continued access to home dialysis. (Emphasis added).
If you have any questions or need additional information, please contact Lindsay Punzenberger at lindsay@homedialysisalliance.org or 202-466-4721. For a list of organizations participating in the Alliance’s working groups, please visit our website at www.homedialysisalliance.org .
Sincerely,
Stephanie Silverman Director”
In other word, the Home Dialysis Alliance fears these cuts like the proposed cuts by the CMS will have an effect on both their Medicare patients and programs for home dialysis, which are sponsored by dialysis centers like Fresenius and DaVita. As I am reading this response, if you, your loved one, friends or family are on home dialysis, these cuts affect you, too.
Please sign and share this petition: https://www.change.org/petitions/center-for-medicaid-and-medicare-services-cms-withdraw-the-proposed-cuts-to-dialysis-centers-and-esrd-patients
To write a short form letter, go here: http://www.capwiz.com/dpcitizens/issues/alert/?alertid=62734766&PROCESS=Take+Action
To make a scripted call to your Congressperson/Senators, go here: http://www.capwiz.com/dpcitizens/callalert/index.tt?alertid=62762041
Saturday, July 20, 2013
KIDNEY STORIES: DINNER WITH MY SON AND CMS CUTS TO DIALYSIS CENTERS
This is my son Jim and I having dinner earlier this week. He lives in Phoenix now so I value the time I get to spend with him. As many of you know, I am a ESRD/PKD/dialysis patient that relies on dialysis to stay alive. Polycystic Kidney Disease is an hereditary disease. In my family, I have lost a cousin, an uncle, 2 aunts and my father to PKD. PKD is the most life threatening of all of the most common life threatening genetic diseases. 600,000 of us in America are effected. There are 12.5 million children and adults world-wide affected with cysts on their kidneys that inevitably lead to kidney failure. The number of people who have PKD is greater that the combined number of people with cystic fibrosis, muscular dystrophy, hemophilia, sickle cell anemia, Down's Syndrome and Huntington's Disease. It is twice as common as MS and 20 times more common than CF.
When your kidneys fail because of PKD, you have 3 choices: dialysis, transplant or death. Transplants are hard to come by and take time. I am on 3 waiting lists and the shortest time I have been quoted is 3 years and the longest is 6+. Death is what I am trying to avoid. I want to see my son grow up, progress in his career, (he works for the AZ Diamond backs in their PR department) get married, have children. I'd like to meet my grandchildren. I have to take dialysis 3x/week 4 hours a shot. I have to do this just to live. Without dialysis, I could die in as short as 3-5 days; at the outside maybe a month or two.
Recently, the Center for Medical Services that runs Medicare and Medicaid in response to the cuts passed during the Fiscal Cliff, proposed cuts to dialysis centers, their services and to Medicare patients who rely on dialysis just like me to live. A 2% cut was expected. A 9.4% cut was proposed, amounting to a $970 million dollar cut. The Dialysis Patient Citizens, The National Kidney Foundation and the PKD Foundation all strongly objected. These devastating cuts would have a drastic effect on the medical care we receive at dialysis centers. These effects could include a loss of access to quality care, lead to lowering of the standard of care provided, layoffs of vital dialysis personnel like techs and nurses, cause of closure and consolidation of dialysis centers, and worse yet the rejection of Medicare dialysis patients, who make up 82% of all dialysis patients. Imagine driving several hundred miles a week to obtain life saving dialysis because the center 5 minutes from your home closed.
The CMS knows these cuts are radical and dangerous. They have given members of the public until August 30th to object. All of the organizations that I belong to are urging you to contact your Congresspersons and Senators to register your objections. If we don't object the CMS will assume we don't care or the cuts are not harmful and after January 1, 2014, they will be implemented. You can use this link to send a letter: http://tinyurl.com/qet4zj2 . You can use this link to make a phone call: http://tinyurl.com/n46cfrp. You can write a letter. You can sign a petition: https://www.change.org/petitions/center-for-medicaid-and-medicare-services-cms-withdraw-the-proposed-cuts-to-dialysis-centers-and-esrd-patients. I am personally meeting with my local reps of my pols on this issue in the next two weeks. I have written a letter to the editor to my local and most large national newspapers and TV stations. I'm hitting the bloggers next (Daily Kos, Salon, Politico). I do this for my clinic mates that come in and leave everyday by ambulance, have diabetes, have lost mental acuity, are amputees, walk with walkers and canes, and just are not able to fight back or truly understand what is occurring. I do this for my son, my father, and my unborn grandchildren. Please use the links, write a letter, make a call or sign the petition. My son and I would like to keep having dinner together.
TAGS: CMS, DPC, End, Facebook, Failure, Foundation, Indiana, Jim, Journal, Kidney, Live, Medicare, Myers, NCS, National, Ning, PKD, Renal, Stage, Stories, Tumblr, University, Weebly, WordPress, a, awareness, blood, centers, chronic, cuts, diabetic, dialysis, disease, donate, donation, donor, find, for, fundraiser, kidney, life, list, living, my, organ, polycystic, recipient, save, seeking, share, sharing, spare, transfusion, transplant
Monday, July 15, 2013
KIDNEY STORIES: KEVIN NEEDS A KIDNEY
Kevin is in need of a kidney. He is O blood type.
In June 2012, at Whistler BC, Kevin became the first ever participant and overcomer of the Tough Mudder WHILE ON DIALYSIS. Kevin completed this intense course to bring awareness for his own need of a kidney, but also for the thousands of others across canada who are on the waitlist for a life-saving organ.
His greatest accomplishment is, however..., being a Dad. His daughter Julia just wants her daddy back.
Kevin works hard to stay positive, to bring positivity to this life and to those around him. Are the person who can give him back his life?
Contact St. Paul's Hospital if you think you might be a match for Kevin.
Tel: (604) 806-9027
Toll free: 1-877-922-9822
Email: donornurse@providencehealth.bc.ca
In June 2012, at Whistler BC, Kevin became the first ever participant and overcomer of the Tough Mudder WHILE ON DIALYSIS. Kevin completed this intense course to bring awareness for his own need of a kidney, but also for the thousands of others across canada who are on the waitlist for a life-saving organ.
His greatest accomplishment is, however..., being a Dad. His daughter Julia just wants her daddy back.
Kevin works hard to stay positive, to bring positivity to this life and to those around him. Are the person who can give him back his life?
Contact St. Paul's Hospital if you think you might be a match for Kevin.
Tel: (604) 806-9027
Toll free: 1-877-922-9822
Email: donornurse@providencehealth.bc.ca
TAGS: kevin needs a kidney, Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life,
KIDNEY STORIES: A KIDNEY FOR LUCY
Hello. My name is Lucy. I am 34 years old, and I desperately need a kidney. The first question people ask is why am I in renal failure at such a young age. No, I'm not diabetic nor did I do anything to harm my kidneys. I was born with an auto-immune disease called IgA Nephropathy that destroyed my kidneys. I do periotoneal dialysis every night for nine hours with a machine. Sadly, the machine weak...ens my heart a little more every night. If it gets too weak, then I'm not as good as a candidate for a kidney transplant.
What I desperately need is a kidney. I don't have any family donors. I'm an only child, and much of family is much older and not in good enough health for the transplant. I also have type O blood, which is making it harder to find a donor. I feel horrible for searching in a way, like I'm begging for organs, but I really just want a life beyond this dialysis machine. I want to go back to teaching. I want to travel. I just want a life.
Thanks for reading and have a lovely day.
Hello Ms. Stacy,
I am emailing you because I received an email from the UK Hospital stating that you were interested in checking up on your transplant status on the kidney transplant waitlist. You currently have 445 days on the waitlist and you are listed active. The average wait time that blood type O recipients tend to wait is between 730 – 915 days on the kidney transplant waitlist. I hope this helps with your question, and please call me at (859) 323-1152 for any questions or concerns. Hope you are doing well and hope to call you in soon for that kidney transplant.
Isaac Payne RN, CCTC
Kidney/Pancreas Transplant Coordinator
University of Kentucky Transplant Center
I am emailing you because I received an email from the UK Hospital stating that you were interested in checking up on your transplant status on the kidney transplant waitlist. You currently have 445 days on the waitlist and you are listed active. The average wait time that blood type O recipients tend to wait is between 730 – 915 days on the kidney transplant waitlist. I hope this helps with your question, and please call me at (859) 323-1152 for any questions or concerns. Hope you are doing well and hope to call you in soon for that kidney transplant.
Isaac Payne RN, CCTC
Kidney/Pancreas Transplant Coordinator
University of Kentucky Transplant Center
TAGS:kidney for lucy, Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life,
KIDNEY STORIES: NEW BLOG
ARE DIALYSIS PATIENTS REFUSING TO GET TRANSPLANTS BECAUSE OF THE COSTS OF ANTI-REJECTION MEDICATIONS?
600,000 of American citizens suffer from ESRD and kidney failure. This leaves you with 3 choices: (1) dialysis; (2) a kidney transplant or (3) death. Kidney transplant recipients must take immunosuppressive drugs for the life of their transplant, or they risk losing their new organ. Medicare pays for the transplant and immunosuppressive drugs for 36 months post transplant, but coverage of these critical medications stops unless the beneficiary is Medicare-aged(65) or Medicare-disabled. The Medicare End Stage Renal Disease (ESRD) program pays for dialysis or transplantation for over 600,000 kidney disease patients every year, regardless of age, and has saved millions of lives in the four decades since its enactment. After a transplant, recipients must take immunosuppressive drugs every day for the life of the transplant; failure to do so significantly increases the risk of organ rejection. Kidney recipients, who qualify for Medicare based on their ESRD, rather than on age or other disability, lose Medicare coverage 36 months after the transplant. However, if they remain on dialysis, they have lifetime Medicare eligibility. Transplant recipients often have difficulty finding other coverage for their immunosuppressive drugs after Medicare coverage ends.
Medicare spends an average of $86,316 per year for an individual who is on dialysis and $124,643 during the first year of a kidney transplant. However, after the year of transplant, the cost is much lower at $24,612 for an individual with a functioning kidney transplant. If the transplant fails, the patient returns to dialysis or receives another transplant, each covered again by Medicare.
Extending immunosuppressive coverage beyond the 36-month post-transplant limit would improve outcomes and enable more kidney patients who lack adequate insurance to consider transplantation. Most transplant recipients also have a higher quality of life, and are more likely to return to work than dialysis patients.
Currently, there is a bill pending, S. 323, “The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013,” would extend Medicare Part B coverage for kidney transplant recipients for the purpose of immunosuppressive drugs only. All other Medicare coverage would end 36 months after the transplant. Beneficiaries would be responsible for the appropriate portion of the Part B premium, as well as applicable deductible and coinsurance requirements. For patients who have another form of health insurance, Medicare would be the secondary payer. The bill also requires that group health plans currently providing coverage of immunosuppressive drugs for kidney transplant recipients maintain this coverage. There is a corresponding bill in the House, H.R. 1428: Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013. The Senate version of the bill has been passed out of committee.
Last week, I read a blog I found to be disturbing. Coupled with that, I received a note from one of my friends. The note and the blog indicated that people who were unable to age/disability qualify for Medicare were refusing transplants due to the high costs of the anti-rejection medications. According to Cameron Field and Kidney Buzz, of the 275,000 people are on dialysis in the United States, only 93,000 individuals choose to be listed on the US Kidney Transplant Waiting List. Two thirds of dialysis patients are not listed, while only one third had chosen to list. Does the prospect of Medicare coverage for only 36 months and then the average monthly cost of approximately $2100/month cause people to decline the transplant option? Of course, there may be others reasons to decline; it requires a surgery, the risk of infection, the risk of rejection even if you take the meds, the necessary follow up, and pain, but sources are now saying that it may be possible that up to 34% of dialysis patients are declining transplants due to the cost of anti-rejection meds.
The Dialysis Patient Citizens conducted a survey last year on this issue. 29% said they had other medical conditions. 26% said they were too old. 7% said they were overweight. 6% said their doctors didn’t recommend it. 5% said they were satisfied with dialysis. However, 6% cited financial reasons generally, 4% said they couldn’t afford the surgery, and 2.5% said they couldn’t afford the medications. 17% cited personal reasons. Who knows how many in that 17% didn’t want to disclose financial hardship. So according to the DPC’s data, it between 13% and 30% that aren’t on the list due to financial reasons.
In addition of the 13,000 transplants performed last year and 6,000 of those were from living donors. There are also significant financial barriers to donors, like the wages they lose while in the hospital and travel to the transplant center. Some states will provide reimbursement in the form of tax deductions for these costs. The federal government also provides some grants, but the program is woefully underfunded. The DPC estimates that cost to reimburse someone’s lost wages is about $6k for one surgery. When you look at in in terms of Medicare paying for the transplant surgery ($100,000) and for the cost of anti-rejection drugs ($24,000/yr), travel and lost wages costs are minimal.
If 30% of the people taking dialysis refuse to be listed due to the costs of transplant autoimmune medications, then we are talking about approximately 100,000 people. Your life expectancy on dialysis on average is said to be 3-5 years. Your life expectancy for a transplant, from a living donor functions, on average, 12 to 20 years, while a deceased donor kidney is somewhat less, 8 to 12 years. If you receive a kidney transplant before you are required to begin dialysis then you will live 10 to 15 years longer than if you stayed on dialysis, on average. So, even though a kidney transplant involves major surgery and requires some risk, in comparison it offers you a longer life. Most patients who have been on dialysis before their transplant report having more energy, less restricted diet, and less complications with a kidney transplant than if they had stayed on dialysis.
Is this 13%-30% reluctance of dialysis patients to obtain a kidney transplant a substantial argument in favor of lifetime protection for anti-rejection meds? Maybe it should be.
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Sunday, July 14, 2013
KIDNEY STORIES: NEW BLOG
KIDNEY STORIES : NEW BLOG
THE CENTER FOR DISEASE SERVICES RECENT PROPOSED CUTS TO FUNDING FOR MEDICARE DIALYSIS PATIENTS AND THE MYTH OF SISYPHUS
I was on a conference call this week with the executives from the Dialysis Patient Citizens where we were discussing the CMS’ proposed cuts of payments to dialysis centers and Medicare patients. The speaker mad a very good point that as advocates we must remain consistent. By consistent, he meant that we must be prepared to fight against this issue not just for now, for maybe for a while. That sometimes legislation comes about just not from adjustments made to hot button issues, but from a persistent effort to make your point. You fight not just because it is trendy, but you fight because it is the right thing to do. A fight is more than one round, it is many rounds; it is not a sprint, sometimes it is a marathon. Much like baseball, legislation is 162 games; it is a long season. You must give your best effort, because in the long run there is only one question that really needs to be asked: what is the right thing to do here? It is not a political question; it is not just an ethical question. It is a moral question. It is a lot like corporate responsibility; you look at all sides of an issue and all the viewpoints of the players, then you do what is best for everyone. I have asked myself this question and the answer is very clear to me. The best thing to do for all concerned is to protest, resist and outright fight against such severe cuts to Medicare dialysis patients.
What does Sisyphus have to do with cuts to dialysis centers and Medicare patients? In Greek mythology Sisyphus was a king of Ephedra (now known as Corinth) punished for chronic deceitfulness by being compelled to roll an immense boulder up a hill, only to watch it roll back down, and to repeat this action forever. The idea of course was that the rolling of this rock up to the top of a hill, only to have it roll back down to the bottom would be punishment; an eternal frustration for the former king. In our current climate, legislation can be a lot like that. I don’t have to tell you that on most issuess, the Congress of the United States is divided and deadlocked, and looks to stay that way for a while. A French existentialist, Albert Camus, had another viewpoint of the myth of Sisyphus. The fact that he continued against great odds to roll that rock up and down that hill until he achieved success seemed beautiful. To Camus, the struggle itself was to be admired; success could come, the fight counted!
So why should you encourage your Congressperson and your Senators to fight against these potential cuts? Remember that we only have until August 30th to object. The Center for Medicare and Medicaid Services is the agency responsible for administering Medicare. They were obligated to propose cuts to Medicare funding to dialysis centers as a result of the Fiscal Cliff (The American Taxpayer Relief Act of 2012). Most of the commentators that I read were expecting a 2% cut at the worst. This is a 9.4% cut, almost 10% amounting to an estimated $970 million that goes into effect January 1, 2014. We need to call this to the attention of our legislators, because the CMS will listen to them. Otherwise, they will assume the cuts are not harmful and implement them. The goal here to preserve and protect the care given to dialysis patients, not just at their centers, but for the patients that take dialysis at home as well. We have to ensure all patients have appropriate access to quality care.
THE NUMBERS
There are over 415,000 people with end-stage renal disease receiving dialysis treatments 3 or more times per week to replace kidney function and 82% are Medicare beneficiaries. There are 26 million American Adults that are estimated to have Chronic Kidney Disease (CKD). 1 in 10 people have kidney disease leading to kidney failure, but don’t know it. Their numbers are expected to rise. 2,492,040 are Medicare patients who have CKD, but whose kidneys have not yet failed. 594, 374 Americans do have irreversible kidney failure or End-Stage-Renal-Disease (ESRD), and require either dialysis or a kidney transplant to survive. A person like me that is on dialysis cannot survive long without it; estimates range as low as 5-6 days. Some say you would be lucky to live 2-3 months. Of this group, only 179,631 Americans live with a functioning kidney transplant. 73% of all ESRD patients apply for Medicare to keep themselves alive. The annual cost to Medicare for its ESRD program is $28.4 billion. This amounts to $86, 316 a year Medicare spends on each dialysis patient.
THE REASONS
The reasons we need to act are:
Dialysis centers have already under cuts for funding for their patients; in 2011, the Centers for Medicare & Medicaid Services (CMS) implemented a bundled payment system for dialysis services and built in a 2% reduction in payment. The Sequester further reduced Medicare payments for dialysis by 2% on April 1, 2013.
Continued cuts may deter providers from opening additional facilities at a time when the number of ESRD patients continues to rapidly grow.
The bundled payment system currently does not provide a separate payment for innovation and further cuts will leave little room for new advancements in patient care.
Cuts may result in reduced staffing hours at facilities and a greater burden on staff, which detracts from providing direct patient care.
In January 2013, the Medicare Payment Advisory Committee (MedPAC) finalized a recommendation to maintain the current level of funding for dialysis in 2014. The Chairman noted that the recommendation did not take into account sequestration or recent changes in law, which would reduce payment below MedPAC’s recommendation.
Given that the dialysis bundled payment system is still new, the MedPAC Chairman stated that payment rates should be held constant in order to fully assess the implications of the new payment system on patient care.
The effect the cuts may have on dialysis centers for all dialysis patients is staggering. A proposal to slash reimbursements to kidney dialysis centers in the United States could drive down monies for Fresenius Medical Care AG and Davita Healthcare Partners Inc, two of the world’s leading providers of dialysis services. On July 1, 2013, the day the announcement of the cuts was made by CMS, Fresenius’ stock fell 8.7%. Fresenius receives 30% of its revenue from the CMS. DaVita’s stock not only fell, but it has been written that DaVita would be forced to move towards aggressive cost cutting measure including potential closures. Fresenius operates 2100 dialysis centers in the USA. DaVita has estimated that its 2014 revenues could be so affected by these cuts, that it might cost them $350 million in earnings and lower its earning per share of stock by as much as $2.00. As a result, the bundled payment for ESRD care would be cut from $240.36 per dialysis patient to $216.95, reported Nephrology News & Issues. Altogether, the adjustments would result in a $970 million drop in CMS dialysis payments next year.
A Fresenius spokesman said the company was assessing the 186-page document in which the cuts were proposed.
"Our first impression is that costs and prices have not been adequately taken into account," said the spokesman, who declined to be named. “Proposed cuts of this magnitude simply go too far," said Ron Kuerbitz, chairman of Kidney Care Partners, a prominent coalition of patient advocates, manufacturers, dialysis professionals and care providers.
"We are deeply concerned about the implications for dialysis patients and the sustainability of the Medicare end-stage renal disease system."
Currently, across all dialysis providers, Medicare profit margins are only 3-4 percent (as estimated by the Medicare Payment Advisory Committee – MEDPAC). Since CMS is proposing a 9.4 percent cut to the base rate for Medicare payments, most providers will have to make considerable changes in how they operate in order to cover the most basic costs of care. The National Kidney Foundation is concerned that some providers may not be able to withstand cuts and will have to close facilities and that many others may have to eliminate patient-focused programs, services, and benefits that improve patients’ health and quality of life.
The bottom line appears to be that the Medicare ESRD program may be called into question in which case the people who rely on it to take dialysis would be out in the cold. It could cause layoffs of dialysis personnel, closing of centers, relocating of patients, and instead of life saving dialysis on demand, we would return to rationed dialysis for the few who could afford it and meet the requirements of some dialysis committee. (See “Who Will Die” on You Tube for a viewpoint of what dialysis was like as recently as the 1960’s). . A nearly 10% cut, may adversely affect the quality of care provided by the Medicare ESRD Program. In all likelihood, the proposed cut will endanger the existence of some dialysis units—especially rural, inner-city, and smaller clinics—making it much more difficult for people who must undergo dialysis at least three times a week to receive their care. I take dialysis in Crown Point, Indiana, just 5 mins from my home. If that clinic were to close for lack of Medicare patients, even though I am a private group insurance client, I would be forced to go 3times a week, 4 hours at time wherever they would send me. Where would that be? Chicago? Fort Wayne? Lafayette? South Bend? Indianapolis? What about the trusted relationships we have built up as dialysis patients with our current nurses and techs? They stick 2 needles in my arm every other day; they monitor the amount of fluid they take off and the rate of speed at which they do it. They check my blood pressure and my dry weight ever day because even the smallest of adjustments could lead to headaches, dizziness, nausea, vomiting, heart attacks or even death. As a dialysis patient, you truly place yourself into the medical people’s hands. I am different that every one of the other 40 patients at my center. The nurses and the techs, they know about our subtle differences. They take care of us. They watch out for us. New people in a larger center may not be able to do that; too many patients with too little help and too little time.
If you are on PD dialysis at home, don’t feel too safe. Now if you catheter fails at home you have HD or HD at a center to fall back on. I wonder if this would change too. Food for thought?
ACTION YOU CAN TAKE
There are several things that you can do that would help. First, you have to voice your concerns to your Congressperson and Senators. All of the major organizations that I belong to including the DPC have recommended that we contact our politicians as they CMS might be more inclined to listen to them as well as to us. There are several ways to do that.
If you want to go online and take action you can send a customized letter through the DPC at this site: http://tinyurl.com/qet4zj2. It is a form letter that you can add your personal story to.
If you prefer to call your Congressperson or Senators’ offices here is a link for that: http://tinurl.com/n46cfrp. The DPC provide some sample points to make and they give you the numbers.
If you want to sign a petition online, here is a link for that:
https://www.change.org/petitions/center-for-medicaid-and-medicare-services-cms-withdraw-the-proposed-cuts-to-dialysis-centers-and-esrd-patients
If you want to write a letter to your Congressperson/Senator here is a link for names, and addresses to find them: http://whoismyrepresentative.com/
Here are some ideas for what you could include in a letter:
My name is [YOUR NAME]. I am a dialysis patient/caregiver/spouse/relative and I live in [CITY, TOWN NAME]
I am writing to you to express my outrage over the proposed Medicare cut for my dialysis care by over 9%
I rely on Medicare for my dialysis treatments and would not be alive today without it
These cuts are dangerous and threaten my care. I need my dialysis facility to be able to stay open and have enough staff
Please do what you can to change these terrible cuts to dialysis today
Make sure to tell your friends and family to do the same!
Here is a form letter:
CMS’ Proposed Cuts to the Medicare ESRD Program Put Access to Dialysis Care at Serious Risk
As your constituent and an advocate for kidney care, I am writing to express my very serious concern about and opposition to the Centers for Medicare and Medicaid Services’ (CMS) proposal to cut Medicare’s end-stage renal disease program by nearly 10 percent, or approximately $30 out of the current reimbursement rate of $246 per dialysis session. A cut of this magnitude would be devastating. If this proposed rule is finalized, it will have damaging effects on people with kidney failure.
More than 400,000 Americans have irreversible kidney failure. Approximately 85 percent of these individuals rely on Medicare for their dialysis care.
As you are aware, Medicare-covered dialysis has been subject to numerous reimbursement reductions in recent years. Additional cuts of the scope that CMS proposes could reduce access to care or undermine quality.
I urge you to ensure that Medicare reimbursement for dialysis is sufficient to cover the cost of care. I also urge you to emphasize this point to CMS.
James W. Myers, III
If you want to write to the CMS directly:
WHERE TO CONTACT THE CMS: You may submit comments in one of four ways (please choose only one of the ways
listed):
1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov/. Follow the “Submit a comment" instructions.
2. By regular mail. You may mail written comments to the following address ONLY:
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1526-P,
P.O. Box 8010,
Baltimore, MD 21244-8010.
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following
address ONLY:
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1526-P,
Mail Stop C4-26-05,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period:
a. For delivery in Washington, DC—
CMS-1526-P 3
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW.,
Washington, DC 20201
(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp- in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)
b. For delivery in Baltimore, MD—
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address, call telephone number (410) 786-9994 in advance to schedule your arrival with one of our staff members.
Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.
For information on viewing public comments, see the beginning of the “SUPPLEMENTARY INFORMATION" section.
FOR FURTHER INFORMATION CONTACT:
Michelle Cruse, (410) 786-7540, for issues related to the ESRD PPS.
CMS-1526-P 4
Stephanie Frilling, (410) 786-4507, for issues related to the ESRD PPS wage index, home dialysis training, and the delay in payment for oral-only drugs under the ESRD PPS.
Heidi Oumarou, (410) 786-7942, for issues related to the ESRD market basket.
Anita Segar, (410) 786-4614, for issues related to the ESRD QIP.
Sandhya Gilkerson, (410) 786-4085, for issues related to the clarification of the grandfathering
provision related to the 3-year MLR for DME.
Anita Greenberg (410) 786-4601, for issues related to the clarification of the definition of routinely purchased DME.
Christopher Molling (410) 786-6399, for issues related to DMEPOS technical amendments and corrections.
Hafsa Vahora, (410) 786-7899, for issues related to the implementation of budget neutral fee schedules for splints and casts, and IOLs inserted in a physician’s office.
THE CENTER FOR DISEASE SERVICES RECENT PROPOSED CUTS TO FUNDING FOR MEDICARE DIALYSIS PATIENTS AND THE MYTH OF SISYPHUS
I was on a conference call this week with the executives from the Dialysis Patient Citizens where we were discussing the CMS’ proposed cuts of payments to dialysis centers and Medicare patients. The speaker mad a very good point that as advocates we must remain consistent. By consistent, he meant that we must be prepared to fight against this issue not just for now, for maybe for a while. That sometimes legislation comes about just not from adjustments made to hot button issues, but from a persistent effort to make your point. You fight not just because it is trendy, but you fight because it is the right thing to do. A fight is more than one round, it is many rounds; it is not a sprint, sometimes it is a marathon. Much like baseball, legislation is 162 games; it is a long season. You must give your best effort, because in the long run there is only one question that really needs to be asked: what is the right thing to do here? It is not a political question; it is not just an ethical question. It is a moral question. It is a lot like corporate responsibility; you look at all sides of an issue and all the viewpoints of the players, then you do what is best for everyone. I have asked myself this question and the answer is very clear to me. The best thing to do for all concerned is to protest, resist and outright fight against such severe cuts to Medicare dialysis patients.
What does Sisyphus have to do with cuts to dialysis centers and Medicare patients? In Greek mythology Sisyphus was a king of Ephedra (now known as Corinth) punished for chronic deceitfulness by being compelled to roll an immense boulder up a hill, only to watch it roll back down, and to repeat this action forever. The idea of course was that the rolling of this rock up to the top of a hill, only to have it roll back down to the bottom would be punishment; an eternal frustration for the former king. In our current climate, legislation can be a lot like that. I don’t have to tell you that on most issuess, the Congress of the United States is divided and deadlocked, and looks to stay that way for a while. A French existentialist, Albert Camus, had another viewpoint of the myth of Sisyphus. The fact that he continued against great odds to roll that rock up and down that hill until he achieved success seemed beautiful. To Camus, the struggle itself was to be admired; success could come, the fight counted!
So why should you encourage your Congressperson and your Senators to fight against these potential cuts? Remember that we only have until August 30th to object. The Center for Medicare and Medicaid Services is the agency responsible for administering Medicare. They were obligated to propose cuts to Medicare funding to dialysis centers as a result of the Fiscal Cliff (The American Taxpayer Relief Act of 2012). Most of the commentators that I read were expecting a 2% cut at the worst. This is a 9.4% cut, almost 10% amounting to an estimated $970 million that goes into effect January 1, 2014. We need to call this to the attention of our legislators, because the CMS will listen to them. Otherwise, they will assume the cuts are not harmful and implement them. The goal here to preserve and protect the care given to dialysis patients, not just at their centers, but for the patients that take dialysis at home as well. We have to ensure all patients have appropriate access to quality care.
THE NUMBERS
There are over 415,000 people with end-stage renal disease receiving dialysis treatments 3 or more times per week to replace kidney function and 82% are Medicare beneficiaries. There are 26 million American Adults that are estimated to have Chronic Kidney Disease (CKD). 1 in 10 people have kidney disease leading to kidney failure, but don’t know it. Their numbers are expected to rise. 2,492,040 are Medicare patients who have CKD, but whose kidneys have not yet failed. 594, 374 Americans do have irreversible kidney failure or End-Stage-Renal-Disease (ESRD), and require either dialysis or a kidney transplant to survive. A person like me that is on dialysis cannot survive long without it; estimates range as low as 5-6 days. Some say you would be lucky to live 2-3 months. Of this group, only 179,631 Americans live with a functioning kidney transplant. 73% of all ESRD patients apply for Medicare to keep themselves alive. The annual cost to Medicare for its ESRD program is $28.4 billion. This amounts to $86, 316 a year Medicare spends on each dialysis patient.
THE REASONS
The reasons we need to act are:
Dialysis centers have already under cuts for funding for their patients; in 2011, the Centers for Medicare & Medicaid Services (CMS) implemented a bundled payment system for dialysis services and built in a 2% reduction in payment. The Sequester further reduced Medicare payments for dialysis by 2% on April 1, 2013.
Continued cuts may deter providers from opening additional facilities at a time when the number of ESRD patients continues to rapidly grow.
The bundled payment system currently does not provide a separate payment for innovation and further cuts will leave little room for new advancements in patient care.
Cuts may result in reduced staffing hours at facilities and a greater burden on staff, which detracts from providing direct patient care.
In January 2013, the Medicare Payment Advisory Committee (MedPAC) finalized a recommendation to maintain the current level of funding for dialysis in 2014. The Chairman noted that the recommendation did not take into account sequestration or recent changes in law, which would reduce payment below MedPAC’s recommendation.
Given that the dialysis bundled payment system is still new, the MedPAC Chairman stated that payment rates should be held constant in order to fully assess the implications of the new payment system on patient care.
The effect the cuts may have on dialysis centers for all dialysis patients is staggering. A proposal to slash reimbursements to kidney dialysis centers in the United States could drive down monies for Fresenius Medical Care AG and Davita Healthcare Partners Inc, two of the world’s leading providers of dialysis services. On July 1, 2013, the day the announcement of the cuts was made by CMS, Fresenius’ stock fell 8.7%. Fresenius receives 30% of its revenue from the CMS. DaVita’s stock not only fell, but it has been written that DaVita would be forced to move towards aggressive cost cutting measure including potential closures. Fresenius operates 2100 dialysis centers in the USA. DaVita has estimated that its 2014 revenues could be so affected by these cuts, that it might cost them $350 million in earnings and lower its earning per share of stock by as much as $2.00. As a result, the bundled payment for ESRD care would be cut from $240.36 per dialysis patient to $216.95, reported Nephrology News & Issues. Altogether, the adjustments would result in a $970 million drop in CMS dialysis payments next year.
A Fresenius spokesman said the company was assessing the 186-page document in which the cuts were proposed.
"Our first impression is that costs and prices have not been adequately taken into account," said the spokesman, who declined to be named. “Proposed cuts of this magnitude simply go too far," said Ron Kuerbitz, chairman of Kidney Care Partners, a prominent coalition of patient advocates, manufacturers, dialysis professionals and care providers.
"We are deeply concerned about the implications for dialysis patients and the sustainability of the Medicare end-stage renal disease system."
Currently, across all dialysis providers, Medicare profit margins are only 3-4 percent (as estimated by the Medicare Payment Advisory Committee – MEDPAC). Since CMS is proposing a 9.4 percent cut to the base rate for Medicare payments, most providers will have to make considerable changes in how they operate in order to cover the most basic costs of care. The National Kidney Foundation is concerned that some providers may not be able to withstand cuts and will have to close facilities and that many others may have to eliminate patient-focused programs, services, and benefits that improve patients’ health and quality of life.
The bottom line appears to be that the Medicare ESRD program may be called into question in which case the people who rely on it to take dialysis would be out in the cold. It could cause layoffs of dialysis personnel, closing of centers, relocating of patients, and instead of life saving dialysis on demand, we would return to rationed dialysis for the few who could afford it and meet the requirements of some dialysis committee. (See “Who Will Die” on You Tube for a viewpoint of what dialysis was like as recently as the 1960’s). . A nearly 10% cut, may adversely affect the quality of care provided by the Medicare ESRD Program. In all likelihood, the proposed cut will endanger the existence of some dialysis units—especially rural, inner-city, and smaller clinics—making it much more difficult for people who must undergo dialysis at least three times a week to receive their care. I take dialysis in Crown Point, Indiana, just 5 mins from my home. If that clinic were to close for lack of Medicare patients, even though I am a private group insurance client, I would be forced to go 3times a week, 4 hours at time wherever they would send me. Where would that be? Chicago? Fort Wayne? Lafayette? South Bend? Indianapolis? What about the trusted relationships we have built up as dialysis patients with our current nurses and techs? They stick 2 needles in my arm every other day; they monitor the amount of fluid they take off and the rate of speed at which they do it. They check my blood pressure and my dry weight ever day because even the smallest of adjustments could lead to headaches, dizziness, nausea, vomiting, heart attacks or even death. As a dialysis patient, you truly place yourself into the medical people’s hands. I am different that every one of the other 40 patients at my center. The nurses and the techs, they know about our subtle differences. They take care of us. They watch out for us. New people in a larger center may not be able to do that; too many patients with too little help and too little time.
If you are on PD dialysis at home, don’t feel too safe. Now if you catheter fails at home you have HD or HD at a center to fall back on. I wonder if this would change too. Food for thought?
ACTION YOU CAN TAKE
There are several things that you can do that would help. First, you have to voice your concerns to your Congressperson and Senators. All of the major organizations that I belong to including the DPC have recommended that we contact our politicians as they CMS might be more inclined to listen to them as well as to us. There are several ways to do that.
If you want to go online and take action you can send a customized letter through the DPC at this site: http://tinyurl.com/qet4zj2. It is a form letter that you can add your personal story to.
If you prefer to call your Congressperson or Senators’ offices here is a link for that: http://tinurl.com/n46cfrp. The DPC provide some sample points to make and they give you the numbers.
If you want to sign a petition online, here is a link for that:
https://www.change.org/petitions/center-for-medicaid-and-medicare-services-cms-withdraw-the-proposed-cuts-to-dialysis-centers-and-esrd-patients
If you want to write a letter to your Congressperson/Senator here is a link for names, and addresses to find them: http://whoismyrepresentative.com/
Here are some ideas for what you could include in a letter:
My name is [YOUR NAME]. I am a dialysis patient/caregiver/spouse/relative and I live in [CITY, TOWN NAME]
I am writing to you to express my outrage over the proposed Medicare cut for my dialysis care by over 9%
I rely on Medicare for my dialysis treatments and would not be alive today without it
These cuts are dangerous and threaten my care. I need my dialysis facility to be able to stay open and have enough staff
Please do what you can to change these terrible cuts to dialysis today
Make sure to tell your friends and family to do the same!
Here is a form letter:
CMS’ Proposed Cuts to the Medicare ESRD Program Put Access to Dialysis Care at Serious Risk
As your constituent and an advocate for kidney care, I am writing to express my very serious concern about and opposition to the Centers for Medicare and Medicaid Services’ (CMS) proposal to cut Medicare’s end-stage renal disease program by nearly 10 percent, or approximately $30 out of the current reimbursement rate of $246 per dialysis session. A cut of this magnitude would be devastating. If this proposed rule is finalized, it will have damaging effects on people with kidney failure.
More than 400,000 Americans have irreversible kidney failure. Approximately 85 percent of these individuals rely on Medicare for their dialysis care.
As you are aware, Medicare-covered dialysis has been subject to numerous reimbursement reductions in recent years. Additional cuts of the scope that CMS proposes could reduce access to care or undermine quality.
I urge you to ensure that Medicare reimbursement for dialysis is sufficient to cover the cost of care. I also urge you to emphasize this point to CMS.
James W. Myers, III
If you want to write to the CMS directly:
WHERE TO CONTACT THE CMS: You may submit comments in one of four ways (please choose only one of the ways
listed):
1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov/. Follow the “Submit a comment" instructions.
2. By regular mail. You may mail written comments to the following address ONLY:
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1526-P,
P.O. Box 8010,
Baltimore, MD 21244-8010.
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following
address ONLY:
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1526-P,
Mail Stop C4-26-05,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period:
a. For delivery in Washington, DC—
CMS-1526-P 3
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW.,
Washington, DC 20201
(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp- in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)
b. For delivery in Baltimore, MD—
Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
7500 Security Boulevard,
Baltimore, MD 21244-1850.
If you intend to deliver your comments to the Baltimore address, call telephone number (410) 786-9994 in advance to schedule your arrival with one of our staff members.
Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.
For information on viewing public comments, see the beginning of the “SUPPLEMENTARY INFORMATION" section.
FOR FURTHER INFORMATION CONTACT:
Michelle Cruse, (410) 786-7540, for issues related to the ESRD PPS.
CMS-1526-P 4
Stephanie Frilling, (410) 786-4507, for issues related to the ESRD PPS wage index, home dialysis training, and the delay in payment for oral-only drugs under the ESRD PPS.
Heidi Oumarou, (410) 786-7942, for issues related to the ESRD market basket.
Anita Segar, (410) 786-4614, for issues related to the ESRD QIP.
Sandhya Gilkerson, (410) 786-4085, for issues related to the clarification of the grandfathering
provision related to the 3-year MLR for DME.
Anita Greenberg (410) 786-4601, for issues related to the clarification of the definition of routinely purchased DME.
Christopher Molling (410) 786-6399, for issues related to DMEPOS technical amendments and corrections.
Hafsa Vahora, (410) 786-7899, for issues related to the implementation of budget neutral fee schedules for splints and casts, and IOLs inserted in a physician’s office.
Saturday, July 13, 2013
KIDNEY STORIES: A KIDNEY FOR DAVID
David is a 34 year old devoted father and wonderful husband with ESRD (End Stage Renal Disease). He has been on dialysis and waiting for a kidney since 2008. He is blood type O+. Please click about below to learn more about his story.
Description
At the age of 14, David got strep throat. When it was left untreated by his physician, it shut down his vital organs resulting in both of his kidneys being severely damaged which is known as post-streptococcal glomerulonephritis. He was able to maintain a normal life on medication for 14 more years. In 2008, David began Peritoneal Dialysis. In 2012, David had to begin hemodialysis as PD was no longer working well. David would like to receive a kidney so that he can resume a normal life again and be able to work full time and be more active in playing with his 2 year old son. David is listed at Loyola University Medical Center in Maywood, IL. You may reach out to Loyola Transplant's Team at 708-327-4897. Loyola participates in paired kidney matching program, so anyone with any blood type that is willing to donate in my honor will be appreciated.
TAGS: Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life, kidney for david
KIDNEY STORIES: NONA NEEDS A KIDNEY
My mother in law, Jan, needs a kidney. She is 64 years old with polycystic kidney disease.
Description
My mother in law, Jan, needs a kidney. She is 64 years old with polycystic kidney disease. Jan is married, a mother of two and grandmother to 3 year old twin girls. Her blood type is O positive. Jan's kidney center is University of Colorado Hospital, Denver Colorado. Jan goes above and beyond for her family and friends. She is someone who gives all of herself to us and now it is her turn. Jan is in need of the ultimate gift, the gift of life. Please help her.
TAGS: Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life,
Friday, July 12, 2013
KIDNEY STORIES: FINDING A KIDNEY FOR RACHEL
This is the OFFICIAL Facebook page of Rachel's. Dedicated to finding her a living Kidney donor. Time is of the essance and we need your help.
Description
Rachel is in End stage renal failure. Our mission is to help find a living kidney donor for Rachel and to raise awareness about early detection and signs of diabetes so that no other child goes undiagnosed. Rachel was diagnosed type1 diabetic at the age of 3. Her blood sugar was 1,389. Through the years, diabetes has taken a toll on her body. She has lost her vision, lost half of her left leg, in kidney failure, had had 2 mild heart attacks and had a pulmonary embolism. Rachel does dialysis 3 times a week for 4 hours.The number for further information and to get tested is 1-317-944-4370 Ask for Kelly Coffee.
https://www.facebook.com/FindingRachelAKidneyDonorwww.facebook.com/kidneystories
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recipient, seeking, awareness, National Kidney Foundation, Indiana University,
sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease,
chronic kidney disease, kidney for, diabetic, save my life, living kidney
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fundraiser, donate life,
KIDNEY STORIES: HELP MICHAEL GET A KIDNEY
Help find a living kidney donor for our friend Michael. This is the direct line to the transplant coordinator if you can help. 720-848-0855.
Description
This page was created to help share Michael's story . We're hoping that the more people know about live donation the better the chance of finding a donor for Michael.
If you are wanting to donate directly to Mike or do a Paired donation, this is the contact you must make. And please be persistant. If you dont get a return call right away, please call again: Thank you from Michael and friends. Pl...ease call the kidney translpant coordinator at University of Colorado Hospital
Telephone: 720-848-0855
Blood type B or O, or you can be a Paired Donor with any blood type.
Prior to donation any potential living donor will need to be up to date on age appropriate health maintenance (colonoscopy, Pap, Mammo etc.)
People that are interested- have them call to donor team- the donor coordinator will then do a quick questionnaire over the phone and will also explain the process again.
Step 1: fill out a donor screening form
Step 2: send back Donor screening form- Nurse to review it
Step 3: first round of testing (height, weight , and blood pressure checked by provider, 24 hour collection- this checks kidney function. (again this can be done out of state)Ã if normal will proceed to step 4
Step 4: Full work up including, social worker phone call or visit (again this can be done out of state)
Step 5: Once coordinator receives the tests- potential donor will presented to our team
Step 6: if approved by our team- schedule surgery
Step 7: Pre-op (out of town donors will meet with the team, including surgeon and possibly psychology)
Step 8: surgery
https://www.facebook.com/HelpMichaelPasturGetAKidney
If you are wanting to donate directly to Mike or do a Paired donation, this is the contact you must make. And please be persistant. If you dont get a return call right away, please call again: Thank you from Michael and friends. Pl...ease call the kidney translpant coordinator at University of Colorado Hospital
Telephone: 720-848-0855
Blood type B or O, or you can be a Paired Donor with any blood type.
Prior to donation any potential living donor will need to be up to date on age appropriate health maintenance (colonoscopy, Pap, Mammo etc.)
People that are interested- have them call to donor team- the donor coordinator will then do a quick questionnaire over the phone and will also explain the process again.
Step 1: fill out a donor screening form
Step 2: send back Donor screening form- Nurse to review it
Step 3: first round of testing (height, weight , and blood pressure checked by provider, 24 hour collection- this checks kidney function. (again this can be done out of state)Ã if normal will proceed to step 4
Step 4: Full work up including, social worker phone call or visit (again this can be done out of state)
Step 5: Once coordinator receives the tests- potential donor will presented to our team
Step 6: if approved by our team- schedule surgery
Step 7: Pre-op (out of town donors will meet with the team, including surgeon and possibly psychology)
Step 8: surgery
https://www.facebook.com/HelpMichaelPasturGetAKidney
TAGS: help michael get a kidney, Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life,
Thursday, July 11, 2013
KIDNEY STORIES: WHO GETS THE KIDNEY?
Who Gets the Kidney? 5 Changes to the Allocation System
More than 96,000 Americans are currently on the waiting list for a life-saving kidney and if this year follows the trend of years past, there will only be about 16,500 kidneys donated. Clearly, the demand is far greater than the supply and therefore, no policy for allocating donor kidneys can possibly match every patient in need with a donor. However, when it comes to deceased donor transplants, recently announced changes to the allocation rules are an improvement over the current system. These changes were made by the Organ Procurement and Transplant Network (OPTN) and the United Network for Organ Sharing (UNOS).
1) Priority for the Most Highly-Sensitized
Transplant candidates who are only likely to match with 0-2% of deceased donors (CPRA score of 100%-98%) because they are highly-sensitized will be placed at the top of the kidney transplant wait list in order to help increase their chance of receiving a transplant.
Candidates with a less than 1% likelihood of matching (CPRA score of 100%) will also get first priority at receiving a kidney from anywhere in the country if that kidney couldn’t be matched to a highly-sensitized patient with a CPRA score of 100-98% in the local transplant unit or region where the organ was donated. While these candidates are still likely to remain on the list for five or more years, this new prioritization will provide them more opportunities to receive a transplant than under the current system.
In addition, under the new policy, candidates with a CPRA score of 20% or above will be assigned priority points that will help improve their chance at receiving a transplant when a match is available.
2) Blood Type B and Minority Access
People on the waiting list whose blood type is B will be able to receive kidneys from donors with blood types A2 and A2B under the new policy. However, not all candidates with type B blood can successfully accept a kidney from A2 and A2B donors, so the candidate will first have to undergo a blood test to see how their body will respond to a donation with these blood types.
Since many minorities have blood type B, expanding the blood types from which type B candidates can receive donor kidneys may slightly increase the number of minorities receiving kidney transplants. This can, help reduce racial disparities in access to kidney transplantation.
3) Improvements to the Waitlist
The new policy sets back the clock for adults 18 years and older who are on the transplant waiting list to the day they started dialysis. Candidates will still be able to accrue time on the wait list when registered with a GFR of 20 ml/minute or less. So regardless of when a patient is actually evaluated for the transplant waiting list, once they are placed on the list, their time spent on dialysis counts in regards to how they are prioritized on the list. This policy reduces disparities in transplantation among the under-served who may not have been prepared to pursue the option of transplantation when first starting dialysis. For children under 18, waitlist time is established based on the day they registered for a kidney transplant or the day they began dialysis, whichever occurred first. Children will still be able to accrue waiting time without being on dialysis.
4) Life-Expectancy Matching for the Top 20% of KidneysThe new policy will match recipients and deceased donors according to the “life expectancy” of the kidney in about 20% of the kidneys. Candidates who are expected to need a kidney for the longest amount of time will be matched with the kidneys expected to function the longest.
This policy scores deceased donor kidneys using the kidney donor profile index (KDPI) to determine how long the kidney is expected to last. Transplant candidates are also scored using the Estimated Post-transplant Survival (EPTS). The EPTS is not a score based solely on age, but on other health factors such as whether the patient had received a prior transplant, diabetes status and time on dialysis.
While it is likely that mostly younger, healthier patients will end up with lower EPTS scores and receive priority for the kidneys with a KDPI between 0-20% (the top 20% of kidneys expected to function the longest), this policy will encourage more efficient matching of donated kidneys. It may also reduce the number of repeat transplants for these recipients. In addition, candidates will have to consent to receive a kidney in the bottom 15% (a KDPI of 85% or higher) since these kidneys are expected to have a shorter functioning life span than kidneys with a lower KDPI. Kidneys with a KDPI of 85% or higher will also be offered to a wider geographic area. For those candidates who are more likely to immediately benefit from a transplant rather than remain on dialysis, this will allow quicker access to a kidney transplant.
5) Priority for Living Organ Donors
In the rare instances where a living donor (of any organ or part of an organ) needs a kidney transplant, they will also be given priority assignment for organs with any KDPI score, including those in the top 20%. The National Kidney Foundation believes prioritizing prior living organ donors is ethical and fairly honors the gift they made.
ExceptionsWhile rarely used, a transplant physician’s right to give a donated kidney out of order, due to medical urgency is protected under this policy. However, all physicians in the local transplant region must agree to the change.
The National Kidney Foundation anticipates that this new kidney allocation policy will protect the gift of life. The policy will extend the length of time a transplanted kidney functions for a recipient, improve equity in the waitlist and improve the ability for those with rare blood types and high sensitivity to receive a deceased donor transplant.
However, there are still too few kidney donors to meet the needs of the more than 96,000 patients on the kidney transplant waitlist. Learn more about organ donation today!
TAGS: CMS, Cuts to dialysis centers funding, kidney, kidney donations, kidney failure, kidney transplant, kidneystories, National Kidney Foundation, polycystic kidney disease, UNOS and tagged awareness, blood, chronic kidney disease, diabetic, dialysis, donate life, donor, End Stage Renal Failure, Facebook, find a kidney for, fundraiser, Indiana University, Jim Myers, kidney, kidney disease, kidney for, Kidney Stories, Live Journal, living kidney donor, National Kidney Foundation, NCS, Ning, organ donation, polycystic kidney disease, recipient, save my life, seeking, share a spare, sharing, transfusion, transplant list, Tumblr, UNOS, Weebly, WordPress by kidneystories
1) Priority for the Most Highly-Sensitized
Transplant candidates who are only likely to match with 0-2% of deceased donors (CPRA score of 100%-98%) because they are highly-sensitized will be placed at the top of the kidney transplant wait list in order to help increase their chance of receiving a transplant.
Candidates with a less than 1% likelihood of matching (CPRA score of 100%) will also get first priority at receiving a kidney from anywhere in the country if that kidney couldn’t be matched to a highly-sensitized patient with a CPRA score of 100-98% in the local transplant unit or region where the organ was donated. While these candidates are still likely to remain on the list for five or more years, this new prioritization will provide them more opportunities to receive a transplant than under the current system.
In addition, under the new policy, candidates with a CPRA score of 20% or above will be assigned priority points that will help improve their chance at receiving a transplant when a match is available.
2) Blood Type B and Minority Access
People on the waiting list whose blood type is B will be able to receive kidneys from donors with blood types A2 and A2B under the new policy. However, not all candidates with type B blood can successfully accept a kidney from A2 and A2B donors, so the candidate will first have to undergo a blood test to see how their body will respond to a donation with these blood types.
Since many minorities have blood type B, expanding the blood types from which type B candidates can receive donor kidneys may slightly increase the number of minorities receiving kidney transplants. This can, help reduce racial disparities in access to kidney transplantation.
3) Improvements to the Waitlist
The new policy sets back the clock for adults 18 years and older who are on the transplant waiting list to the day they started dialysis. Candidates will still be able to accrue time on the wait list when registered with a GFR of 20 ml/minute or less. So regardless of when a patient is actually evaluated for the transplant waiting list, once they are placed on the list, their time spent on dialysis counts in regards to how they are prioritized on the list. This policy reduces disparities in transplantation among the under-served who may not have been prepared to pursue the option of transplantation when first starting dialysis. For children under 18, waitlist time is established based on the day they registered for a kidney transplant or the day they began dialysis, whichever occurred first. Children will still be able to accrue waiting time without being on dialysis.
4) Life-Expectancy Matching for the Top 20% of KidneysThe new policy will match recipients and deceased donors according to the “life expectancy” of the kidney in about 20% of the kidneys. Candidates who are expected to need a kidney for the longest amount of time will be matched with the kidneys expected to function the longest.
This policy scores deceased donor kidneys using the kidney donor profile index (KDPI) to determine how long the kidney is expected to last. Transplant candidates are also scored using the Estimated Post-transplant Survival (EPTS). The EPTS is not a score based solely on age, but on other health factors such as whether the patient had received a prior transplant, diabetes status and time on dialysis.
While it is likely that mostly younger, healthier patients will end up with lower EPTS scores and receive priority for the kidneys with a KDPI between 0-20% (the top 20% of kidneys expected to function the longest), this policy will encourage more efficient matching of donated kidneys. It may also reduce the number of repeat transplants for these recipients. In addition, candidates will have to consent to receive a kidney in the bottom 15% (a KDPI of 85% or higher) since these kidneys are expected to have a shorter functioning life span than kidneys with a lower KDPI. Kidneys with a KDPI of 85% or higher will also be offered to a wider geographic area. For those candidates who are more likely to immediately benefit from a transplant rather than remain on dialysis, this will allow quicker access to a kidney transplant.
5) Priority for Living Organ Donors
In the rare instances where a living donor (of any organ or part of an organ) needs a kidney transplant, they will also be given priority assignment for organs with any KDPI score, including those in the top 20%. The National Kidney Foundation believes prioritizing prior living organ donors is ethical and fairly honors the gift they made.
ExceptionsWhile rarely used, a transplant physician’s right to give a donated kidney out of order, due to medical urgency is protected under this policy. However, all physicians in the local transplant region must agree to the change.
The National Kidney Foundation anticipates that this new kidney allocation policy will protect the gift of life. The policy will extend the length of time a transplanted kidney functions for a recipient, improve equity in the waitlist and improve the ability for those with rare blood types and high sensitivity to receive a deceased donor transplant.
However, there are still too few kidney donors to meet the needs of the more than 96,000 patients on the kidney transplant waitlist. Learn more about organ donation today!
TAGS: CMS, Cuts to dialysis centers funding, kidney, kidney donations, kidney failure, kidney transplant, kidneystories, National Kidney Foundation, polycystic kidney disease, UNOS and tagged awareness, blood, chronic kidney disease, diabetic, dialysis, donate life, donor, End Stage Renal Failure, Facebook, find a kidney for, fundraiser, Indiana University, Jim Myers, kidney, kidney disease, kidney for, Kidney Stories, Live Journal, living kidney donor, National Kidney Foundation, NCS, Ning, organ donation, polycystic kidney disease, recipient, save my life, seeking, share a spare, sharing, transfusion, transplant list, Tumblr, UNOS, Weebly, WordPress by kidneystories
Wednesday, July 10, 2013
KIDNEY STORIES: KITCH NEEDS A KIDNEY
Bill needs a kidney...A live donor is his best option.
Please consider our plea .
Please share and like this page.....we know someone is out there...
We just need our loved ones help to spread the message and consider donation.
Please share and like this page.....we know someone is out there...
We just need our loved ones help to spread the message and consider donation.
Description
My husband my life. The page is for him. We met over 4 years ago and married this past April.
He is the strongest person I know. He has overcome obstacles in his life that some people couldnt even talk about.
Now he is in the fight for his life he has no control over. We are still in the process (long process), of being accepted
to the transplant program. But finding a living donor during this pr...ocess is his best option. Some testing is all it takes to be
accepted as a donor. The surgery is very simple. All covered by recipients insurance. But we are not begging for a kidney.
Just putting it out there. If youre not a match for him, you can be a match for someone else.
Just think if it was your loved one. What would you do?
If you have any questions please feel free to contact me or Bill.
Thank you for your support!!
He is the strongest person I know. He has overcome obstacles in his life that some people couldnt even talk about.
Now he is in the fight for his life he has no control over. We are still in the process (long process), of being accepted
to the transplant program. But finding a living donor during this pr...ocess is his best option. Some testing is all it takes to be
accepted as a donor. The surgery is very simple. All covered by recipients insurance. But we are not begging for a kidney.
Just putting it out there. If youre not a match for him, you can be a match for someone else.
Just think if it was your loved one. What would you do?
If you have any questions please feel free to contact me or Bill.
Thank you for your support!!
TAGS: kitch needs a kidney like yesterday, Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life,
KIDNEY STORIES: LET'S LENGTHEN LYNN'S LIFE
Sandra Lynne Young is coping with kidney failure. This page is to alert others to her need for a kidney transplant and to connect you to info on kidney disease and organ donation. Any potential donors willing to be tested should click the Message button.
Description
A dear lifelong friend, Sandra Lynne Young (aka Lynne Young II) of Zion, IL, has been through quite an ordeal in the past few years due to kidney failure. She endured a grueling period of dialysis which actually nearly cost her her life in the Fall of 2011 due to the formation of several blood clots. Miraculously she recovered after several surgeries and actually was able to enjoy a reprieve from... dialysis when it appeared her kidneys were again functioning on their own. However the kidney problems have returned and doctors want to put her back on dialysis and are reactivating her on the donor waiting list. She dreads the idea of going through dialysis again and the waiting list for a kidney is very long. Sandra wants to live and enjoy her family. So this page is to share her story and appeal to any who would consider becoming a kidney donor for Lynne.
Even if you are not a potential donor, please feel free to like and/or share this page as this will drive exposure and awareness. Please leave a message if you might be willing to help Lynne.
This page will be revised and updated a little later. I'm sorry for the incomplete nature of this page at the moment.
Thank you for your time and concern.
Praying for good health for all.
Sandra had to be hospitalized again on Saturday, December 29th and has learned that she must resume dialysis 3 times a week until she receives a new kidney. Poor thing brought in the new year in pain and in the hospital.
Even if you are not a potential donor, please feel free to like and/or share this page as this will drive exposure and awareness. Please leave a message if you might be willing to help Lynne.
This page will be revised and updated a little later. I'm sorry for the incomplete nature of this page at the moment.
Thank you for your time and concern.
Praying for good health for all.
Sandra had to be hospitalized again on Saturday, December 29th and has learned that she must resume dialysis 3 times a week until she receives a new kidney. Poor thing brought in the new year in pain and in the hospital.
Anyone who might be interested in becoming a potential donor for Lynne, please contact Stephanie Albano, Living Donor Coordinator, Froedtert Hospital Milwaukee @ 1-414-805-0310. She will be more than happy to do an 'over the phone' assessment with you.
You can also contact her if you would like more information regarding donor processing or any other questions you may have. If she is not available please don't hesitate to leave a message. She will contact you as soon as possible.
Please know that any and all information given is completely confidential.
You can also contact her if you would like more information regarding donor processing or any other questions you may have. If she is not available please don't hesitate to leave a message. She will contact you as soon as possible.
Please know that any and all information given is completely confidential.
TAGS: let's lengthen lynns life, Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life,
KIDNEY STORIES: HELP BARB FIND A KIDNEY
Barbara Julian Moore has been suffering from Brights kidney disease since she was a young child. In our family, we've had several family members pass from this terrible disease. Please consider helping Barbara!
Description
Please help Barbara find a kidney! She is currently on her last access and once it goes bad she will have to live with a haemocath and those are no fun. Several family members have been tested and no one is a match or can't due to health reasons. PLEASE consider donating she is looking for A Positive Blood type. She has a teenager son at home and 5 grandchildren. Barbara loves her family very much and there nothing more she would rather do is spend time with her sisters and family.
TAGS: find a kidney for barb, Ning, Live Journal, Tumblr, Weebly, WordPress, Facebook, Kidney Stories, Jim Myers, kidney, dialysis, blood, transfusion, donor, recipient, seeking, awareness, National Kidney Foundation, Indiana University, sharing, kidney disease, End Stage Renal Failure, polycystic kidney disease, chronic kidney disease, kidney for, diabetic, save my life, living kidney donor, organ donation, find a kidney for, NCS, share a spare, transplant list, fundraiser, donate life,
Sunday, July 7, 2013
KIDNEY STORIES : DOES THE IMMUNOSUPPRESSIVE DRUG BILL CONFLICT WITH THE RECENT BACKLASH AGAINST THE CMS DECISION TO CUT FUNDING TO DIALYSIS PATIENTS
KIDNEY STORIES: DOES THE IMMUNOSUPPRESSIVE DRUG BILL CONFLICT WITH THE RECENT BACKLASH AGAINST THE CMS SUGGESTION TO CUT FUNDING TO DIALYSIS PATIENTS?
DOES THE IMMUNOSUPPRESSIVE DRUG BILL CONFLICT WITH THE RECENT BACKLASH AGAINST THE CMS SUGGESTION TO CUT FUNDING TO DIALYSIS PATIENTS?
When a patient’s kidneys fail, he has 3 choices; (1) dialysis; (2) a preemptive transplant; or (3) death. Although there is little question that a transplant results in the best lifestyle for a patient, more often than not, dialysis is the initial course chosen. This occurs because there is a shortage of available kidneys and donors. Over 90% of us with End Stage Renal Disease end up starting our initial course of treatment on dialysis. http://www.bidmc.org/Centers-and-Departments/Departments/Transplant-Institute/Kidney/The-Benefits-of-Transplant-versus-Dialysis.aspx. According to the NKF, 26 Million Americans have Chronic Kidney Disease. 415,013 ESRD patients receive dialysis at least 3 times per week to replace kidney function. See flyer from NKF called “Kidney Disease by the Numbers.” www.kidney.org/advocacy/…/KIDNEY_DISEASE_BY_THE_NUMBERS. Pdf.
Recently, a question was raised to me if the National Kidney Foundation prefers preserving the dialysis system over transplants. As the Advocate for the State of Indiana for the NKF, I would say this is incorrect.
The NKF has proposed the End the Wait program, a bold, progressive proposal to universally lessen the wait for a transplanted kidney across the U.S. to less than a year. http://www.kidney.org/transplantation/endthewait/index.cfm. The proposed initiative is part of a much larger legislative & social plan called the 2013-2018 Strategic Plan for the direction the NKF wants to take with legislation, education, awareness, prevention and treatment. https://www.kidney.org/about/strategic_plan/2013/. Part of both of those initiatives is legislation called “The Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2013,” (S.323 and H.R.1428).
This bill addresses the issue concerning Kidney transplant recipients who are eligible for Medicare due to irreversible kidney failure, but who are not Medicare-aged or Medicare-disabled, lose their Medicare three years after the transplant. This legislation would continue access to Medicare indefinitely, but would cover anti-rejection medications only. All other Medicare would end after three years for kidney recipients, as under current law. https://secure2.convio.net/nkf/site/Advocacy?cmd=display&page=UserAction&id=115. The Medicare End Stage Renal Disease (ESRD) program pays for dialysis or transplantation for over 600,000 kidney disease patients every year, regardless of age, and has saved millions of lives in the four decades since its enactment. After a transplant, recipients must take immunosuppressive drugs every day for the life of the transplant; failure to do so significantly increases the risk of organ rejection. Kidney recipients, who qualify for Medicare based on their ESRD rather than on age or other disability, lose Medicare coverage 36 months after the transplant. However, if they remain on dialysis, they have lifetime Medicare eligibility. Transplant recipients often have difficulty finding other coverage for their immunosuppressive drugs after Medicare coverage ends.
Medicare spends an average of $86,316 per year for an individual who is on dialysis and $124,643 during the first year of a kidney transplant. However, after the year of transplant, the cost is much lower at $24,612 for an individual with a functioning kidney transplant. If the transplant fails, the patient returns to dialysis or receives another transplant, each covered again by Medicare. Notice that on a per year average, per patient, we are talking about almost a $60, 000.00/year difference. ($83, 316 - $24, 612= $58, 704). https://nkfadvocacy.wordpress.com/immunosuppressive-drug-coverage/.
Extending immunosuppressive coverage beyond the 36-month post-transplant limit would improve outcomes and enable more kidney patients who lack adequate insurance to consider transplantation. Most transplant recipients also have a higher quality of life, and are more likely to return to work than dialysis patients.
This is particularly necessary legislation when you consider that the average lifespan of a transplanted kidney from a living donor kidney functions, on average, 12 to 20 years (144 months to 240 months), and a deceased donor kidney from 8 to 12 years(96 months to 144 months). - See more at: http://www.bidmc.org/Centers-and-Departments/Departments/Transplant-Institute/Kidney/The-Benefits-of-Transplant-versus-Dialysis.aspx#sthash.wRrhXYBV.dpuf. It becomes even more striking when you take into account that the average life expectancy of a dialysis patient is five and six years. http://www.kidneyfund.org/kidney-health/kidney-basics/common-questions.html. Further complicating the issue, according to the NKF, of the 415,013 Americans currently on dialysis, as of March, 2013, 95,474 are awaiting a kidney transplant. Last year, 16,485 Americans received a kidney transplant. Every 10 minutes, someone is added to the transplant list, totaling about 3,000 each month. Every day, 19 people on the list die awaiting a transplant. Last year, 4,903 patients died while waiting for a kidney transplant. http://www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats.cfm.
As you can see, transplants and helping people pay for anti-rejection medications are a legislative priority, but by no means have they forsaken those of us on dialysis.
Proof of the NKF’s support of dialysis patients was shown earlier this week. On Monday July 1, the Centers for Medicare & Medicaid Services (CMS) released the annual proposed rule to update Medicare payment to dialysis providers beginning January 1, 2014 and to modify the Quality Incentive Program (QIP), which reduces reimbursement to providers if they don’t meet specified quality measures. What is most notable about this year’s proposed payment rule (also known as the End-stage Renal Disease Prospective Payment System – ESRD PPS) is that in response to legislation passed by Congress, CMS proposed to cut payment to dialysis providers by 9.4 percent. https://nkfadvocacy.wordpress.com/2013/07/03/medicare-proposes-deep-cuts-for-dialysis/#more-684.
The American Taxpayer Relief Act (ATRA)(The Fiscal Cliff) of 2012 required CMS to reduce the payment rate based on the decline in the use of injectable drugs (and their oral equivalents), most notably, erythropoietin stimulating agents (ESA). While ATRA required CMS to reduce the payment rate it did not specify the amount of the reduction, but instead to factor in the decline in the use of these drugs and the current price of the drugs. The National Kidney Foundation (NKF) understands CMS is required by law to reduce the payment rate. However, NKF is concerned about the impact that this large of a cut may have on patient care across the country.
According to the NKF, Currently, across all dialysis providers, Medicare profit margins are only 3-4 percent (as estimated by the Medicare Payment Advisory Committee – MEDPAC). Since CMS is proposing a 9.4 percent cut to the base rate for Medicare payments, most providers will have to make considerable changes in how they operate in order to cover the most basic costs of care. NKF is concerned that some providers may not be able to withstand cuts and will have to close facilities and that many others may have to eliminate patient-focused programs, services, and benefits that improve patients’ health and quality of life. Rather than wait and see how dialysis facilities respond to the cuts, we hope that Congress and CMS will engage in a meaningful dialogue with dialysis providers, patient groups, professionals, and others involved in caring for patients to identify ways to reduce the proposed cuts while still complying with the law. https://nkfadvocacy.wordpress.com/2013/07/03/medicare-proposes-deep-cuts-for-dialysis/#more-684.
Also included in this proposed rule are a number of changes to the Medicare ESRD Quality Incentive Program (QIP) that if finalized would impact Medicare payments in 2016. The QIP is a provider penalty program that has been in place since 2012. Dialysis facilities can receive a 0-2 percent reduction in Medicare payments for not meeting the specified quality measures. Each year CMS makes changes to the program to add, remove, or revise quality measures based on new standards of care, or the availability of new data. CMS is proposing to include five new measures that facilities will start being measured on in 2014.
These include:
◾The percentage of in-center and home dialysis patients with hypercalcemia (a serum calcium level above 10.2%)
◾The percentage of hemodialysis (including home) patients with a bloodstream infection
◾The percentage of dialysis patients that the facility states have been educated and advised on the risks, benefits and options for anemia treatment
◾A requirement to report on iron therapy for all pediatric patients
◾A requirement to report certain health related conditions that each dialysis patient has. These conditions include heart disease, hypertension, diabetes, drug and alcohol dependence, tobacco use as well as others.
If finalized, these five measures will be in addition to the six that are currently being measured. http://www.dialysisreports.org/ESRDMeasures.aspx.
The NKF reminds us that given the proposed 9.4 percent cut to dialysis payments in 2014, we note that for many facilities implementing strategies to achieve some of these quality measures may be particularly challenging. However, NKF believes quality measurement is an important way to drive improvement in the quality of care patients receive. As we continue to review the proposed regulation, we will consider the impact of the proposed changes to dialysis payment and to the QIP on patient care and provide recommendations to CMS before the agency issues a final rule. As we prepare these recommendations we will call on many of our patient and professional volunteers to weigh in as the experts. Comments are due to CMS August 30, 2013 and we will be sure to share with your our final comment letter and activities around this proposed rule. https://nkfadvocacy.wordpress.com/2013/07/03/medicare-proposes-deep-cuts-for-dialysis/#more-684.
The National Kidney fund has long been ardent supporters of dialysis patients. This includes advocating for the protection of dialysis patient access and the quality of care dialysis patients receive in dialysis centers. (Flyer, “Protect Dialysis Patient Access and Quality of Care,” from the National Kidney Foundation distributed at Advocacy on the Hill, March, 2013). As the NKF notes, Over 415,000 people with end-stage renal disease receive dialysis treatments 3 or more times per week to replace kidney function and 82% are Medicare beneficiaries. Some cuts to dialysis center funding have already taken place:
In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented a bundled payment system for dialysis services and built in a 2% reduction in payment.
Sequestration will further reduce Medicare payments for dialysis by 2% on April 1, 2013.
These cuts on top of the proposed cuts suggested by the CMS may have the following results:
• Continued cuts may deter providers from opening additional facilities at a time when the number of ESRD patients continues to rapidly grow.
• The bundled payment system currently does not provide a separate payment for innovation and further cuts will leave little room for new advancements in patient care.
• Cuts may result in reduced staffing hours at facilities and a greater burden on staff, which detracts from providing direct patient care.
• In January 2013, the Medicare Payment Advisory Committee (MedPAC) finalized a recommendation to maintain the current level of funding for dialysis in 2014. The Chairman noted that the recommendation did not take into account sequestration or recent changes in law, which would reduce payment below MedPAC’s recommendation.
• Given that the dialysis bundled payment system is still new, the MedPAC Chairman stated that payment rates should be held constant in order to fully assess the implications of the new payment system on patient care.
(Flyer, “Protect Dialysis Patient Access and Quality of Care,” from the National Kidney Foundation distributed at Advocacy on the Hill, March, 2013).
The flyer concludes with the following statement: “[The] NKF requests Congress protect patient access to quality dialysis care, by ensuring no further cuts to payment are made.”
The original question for this blog was does the NKF favor dialysis patients over transplants or transplant patients over dialysis patients? At the WDC Advocacy on the Hill Event in March, I was taught to advocate for both the extension of anti-rejection drugs for transplant patients for the rest of their lives as opposed to 36 months and to protect and preserve funding for dialysis centers and patients. It is a very consistent position with the fact that more people whose kidneys fail initially end up on dialysis, and get transplanted kidneys at a later date. They have a new, broad vision lowering the time on a transplant list universally in the USA to 1 years’ time within in the next decade. http://www.kidney.org/transplantation/endthewait/index.cfm; http://www.kidney.org/transplantation/endthewait/etw_recommendations.cfm.
They have a broad, progressive plan for both dialysis patients and transplanted patients that they are in the process of advocating and implementing. (2013-2018 Strategic Plan). https://www.kidney.org/about/strategic_plan/2013/.
I can only conclude that the NKF is saying that so many people end up on dialysis (what is the rate about 90 %) while awaiting a transplant, that in order to improve the transplant conversion rate and extend life, we have to make sure that dialysis patients don’t die while they are waiting. I see these things as congruent, not conflicting. As your advocate, I am currently on dialysis and on 2, possibly 3 waiting lists for a transplanted kidney. The numbers I have cited in this blog are all from the NKF concerning the number of people on dialysis (415,013); the number of people awaiting a transplant (95, 474 as of 3/8/2013); the number of people who received a transplant last year (16, 485); the cost per year, per person for dialysis ($86, 316); the cost per person, per year for anti-rejection meds for a transplanted patient after the first year ($24, 612). The NKF clearly does not favor dialysis over transplantation; on the contrary they recognize that dialysis may very well come first and transplantation second. A number of my fellow advocates from other states were transplanted kidney patients. The NKF sponsored all of us equally. It is very clear that transplantation leads to a better lifestyle. As an Advocate, I celebrate all of my transplanted friends. I too hope someday to be given the gift of life. We are all on the same side of the rope, pulling in the same direction. Kidney disease is a killer. Dialysis and transplantation are our only real alternatives to maintain life.
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