September 23, 2010

Dear Members of Congress:

Dialysis Patient Citizens (DPC) is the nation’s largest patient-led dialysis organization, with more than 22,000 dialysis patients, pre-dialysis patients and family members working together to improve all patients’ quality of life.

As you may know, on July 24, the Centers for Medicare and Medicaid Services (CMS) issued the final rule on Medicare’s new “bundled” payment system for dialysis, which provides a single bundled payment for care and services beginning in January 2011. DPC and its members are grateful that CMS heard patients’ concerns on several points in the final rule, including delaying the inclusion of oral drugs without an injectable equivalent in the bundle until 2014. However, we are concerned about a payment “adjustment” that CMS is planning to make during the transition years, before the new system is fully implemented.  The “adjustment” amounts to a cut in dialysis funding that we believe will undercut the gains that have been made in recent years.

As currently structured, the transition payment adjustment made by CMS will return Medicare dialysis payments to 2007 levels, which goes beyond the 2 percent cut that Congress instructed through the Medicare Improvements for Patients and Providers Act (MIPPA). The transition adjustment is calculated based on the number of facilities going into the new payment system – estimated by CMS to be approximately 40 percent. Facilities must notify CMS by November 1, 2010, of their intent to opt in to the bundle.  We believe it is reasonable to assume that upwards of 60 percent of providers may opt to transition into the new bundled payment system in early. The number could be much higher.

For years, DPC has advocated for Medicare to provide an automatic annual payment update for dialysis care to account for routine increases in costs of care and services.  The positive gains made through Congress’ enactment of an annual payment update will diminish if the transition adjustment is implemented as planned. If dialysis services are underfunded, patient care will be directly impacted, resulting in decreased continuity of care and decreased access.

We believe that if the actual number of facilities that opt in to the new payment system differs from CMS’s estimate, CMS should be required to adjust their 40 percent estimation upward, and likewise adjust the “adjustment” downward - based on actual, rather than anticipated, behavior. Needed funds for providing patients’ life-saving dialysis care should not be removed from the system. We urge Congress to give CMS the authority to correct these estimates without going through rulemaking and base the transition adjustment on actual data received after November 1, 2010.

Thank you for your attention to this important matter that could impact the lives and health of dialysis patients nationwide,

Sincerely,

 
Chad Lennox
Executive Director