Dialysis Patient Citizens News
DPC Elevates Patient Priorities with Medicare Regarding Dialysis Facility Compare Star Ratings
Elena Balovlenkov, R.N. Technical Lead for Dialysis Facility Compare Centers for Medicare & Medicaid Services 7500 Security Boulevard Mail Stop S3-02-01 Baltimore, MD 21224 Dear Elena: To meet your timeline for raising issues to be brought before the DFC Star Rating TEP, DPC recently conducted a survey of our active patient volunteers asking them to identify priority items for quality measures to be included in both DFC star ratings and the QIP. Per the advice of the Kidney Care Quality Alliance (KCQA) consultant on quality measures, we [...]
DOPPS Releases Results on Dialysis Trends from 2010-2014
The Arbor Research Collaborative for Health researches dialysis through their Dialysis Outcomes and Practice Patterns Study (DOPPS), among other programs. The DOPPS Practice Monitor (DPM) recently released trends they observed in dialysis facilities from 2010-2014. Hemoglobin trends The recommended hemoglobin level for a dialysis patient is between 10 – 11 g/dl. From 2010 to 2014, mean hemoglobin (Hgb) levels in dialysis patients declined from 11.5 g/dl to 10.9 g/dl. The percentage of dialysis patients with Hgb under 10 g/dl rose from 8.3% to 19.1%, which is bad news [...]
Department of Health & Human Services Announces Pay-for-Performance Goals
The US Department of Health & Human Services (HHS) recently announced goals for shifting the traditional fee-for-service Medicare payment model to a pay-for-performance model. In a pay-for-performance model, payment is based on the quality rather than quantity of care provided. One HHS goal is to tie 30% of fee-for-service Medicare payments to quality through alternative payment models like Accountable Care Organizations or bundled payments by the end of 2016, and 50% by the end of 2018. The dialysis community has a unique history in this area. Dialysis providers [...]
Affordable Care Act Enrollment Reaches 9.5 Million as February 15 Deadline Approaches
Open enrollment for individual coverage in the Affordable Care Act (ACA)’s public health insurance exchanges began in November of last year. The deadline for enrollment is February 15, 2015. So far approximately 9.5 million people have either newly enrolled or re-enrolled in the exchanges, with 7.1 million enrolling in the 37 states that use the federal marketplace, HealthCare.gov. Of those 7.1 million, approximately 6.2 million received financial assistance to help pay for coverage. Also, 4.16 million re-enrolled in health plans, and 3 million selected a plan for the [...]
Insights with Jack: Accidental Advocate
By Jack Reynolds, DPC Board Member and Patient Ambassador As it is Ground Hog Day, I thought I would come out of my winter hole and blog once more. March is only four weeks away, and it will be time to visit Washington, D.C. and another chance for Dialysis Patient Citizen Ambassadors to bring our issues and concerns to our elected Congressional Representatives and Senators. Although I have made this journey many times since 2005, I am not a “natural” political advocate; and in fact, if not for [...]
Dialysis, ESRD and EEOC
By Devon Osborne, DPC Board Member and Patient Ambassador Back a couple years ago, I had to sue my employer through the EEOC (Equal Employment Opportunity Commission) for violating my rights under the Americans with Disabilities Act. Below is some of my experience doing that. In light of the recent posts and comments here and elsewhere, I figured it was time to post about the process I went through with the EEOC and getting my case filed and accepted. Immediately after I got home the fateful day [...]
DPC’s Jackson Williams Named NAIC Consumer Liaison Representative
The National Association of Insurance Commissioners (NAIC), a membership organization for the nation’s chief insurance regulators, recently named 30 consumer liaison representatives for 2015. Through these representatives, who are committed to the public interest, consumers can interact with NAIC’s membership, the insurance industry and other interested parties. “Our consumer liaison representatives play an integral part in helping the NAIC and regulators protect U.S. insurance consumers,” said Monica J. Lindeen, NAIC President-Elect and Montana Commissioner of Securities and Insurance. “This partnership program is an important component of our [...]
Insights with Jack: Holiday Greetings
By Jack Reynolds, DPC Patient Ambassador and Board Member Seasons come and go, and cold winds blow. Holiday Greetings! Well, I would never have made it as a Hallmark card bard. One of my most vivid recollections of Christmas, which is almost dreamlike now, is lying alone in a hospital room pondering my gloomy fate and thinking about my family and what was going through their minds. The previous day I had met Dr. Condon for the first time, and she had informed me that I had [...]
Dialysis Facility Compare Star Ratings Draw First Challenge to CMS Quality Measures Under Data Quality Act
Skewed geographic distribution of star ratings demonstrates program’s flaws, says Dialysis Patient Citizens WASHINGTON, D.C. (Dec. 16, 2014) — Dialysis Patient Citizens has filed the first challenge to a CMS quality program under the Data Quality Act, contending that the agency’s Dialysis Facility Compare (DFC) star ratings methodology fails to satisfy federal requirements for objectivity and utility in presenting information to the public. The day after being served with the complaint, CMS conceded it should have conducted cognitive testing of this system on consumers, reversing a position the agency had defended for nearly four months. [...]
A Strong Voice for Dialysis Patients
With the gridlock in Congress reaching new heights, it is more important now than ever for dialysis patients to have a strong voice in policymaking. DPC is well-equipped to serve as that voice since it is a patient-led organization (the Board of Directors consists entirely of patients). Joining DPC means you are serious about improving the quality of care for dialysis patients, and sends a signal to legislators that this will be on the top of your mind when you go to the ballot box in November. They [...]
DPC’s Request for Correction complaint to CMS Regarding DFC Star Ratings
Attached is CCSQ’s courtesy copy of the Request for Correction we filed today under the Data Quality Act challenging the methodology to be used in the DFC Star Ratings. The Data Quality Act and the HHS Information Quality Guidelines promulgated pursuant to the Act have been in existence for approximately as long as CMS has collected and reported quality measures. Over the past decade, no stakeholder has ever filed a Request for Correction with CMS pertaining to quality measurements. We take no joy in being the first, but [...]
Insights with Jack: Reflections on Thanksgiving
By Jack Reynolds, DPC Board Member and Patient Ambassador My Grandma Mae lived to be 96 and she had a saying, “One has to learn how to suffer." I think what she really meant was that a person must learn how to handle or manage their suffering whether it be physical, mental, or emotional. Over time most ESRD patients are confronted with a host of these challenges or sufferings. Frankly, I have been spared many of the hospitalizations and complications that many dialysis patients experience. For example, I [...]
Prior Authorization of Non-Emergency Ambulance Transportation to Begin for Dialysis Patients in New Jersey, Pennsylvania and South Carolina
The Centers for Medicare & Medicaid Services (CMS) will begin implementing a prior authorization demonstration program for non-emergent ambulance transport of dialysis patients in New Jersey, Pennsylvania and South Carolina. CMS believes using a prior authorization process will help ensure services are provided in compliance with Medicare coverage rules, specifically that ambulance providers in those states must obtain documentation from physicians prior to the beginning of service. The requirement does not apply to hospital-based ambulances. CMS is taking these actions in response to instances of fraud in [...]
Election Results Shouldn’t Affect ESRD Program, But New Members of Congress Need to be Educated on Medicare’s Role
Republicans gained control of the U.S. Senate in last week's elections, but this change is not expected to affect Congressional policymaking on dialysis issues. While some health care issues involve contentious partisan bickering, historically the nuts-and-bolts, day-to-day operations of the Medicare program have been managed on a bipartisan basis by Congress' professional staff members, overseen by Congressional committee chairs with expertise on Medicare. What will be different is that many new Members of Congress will take office in January who do not have experience with Medicare or ESRD [...]
New Dialysis Quality Rules May Bring Small but Noticeable Changes to Your Care
The Centers for Medicare and Medicaid Services (CMS) recently finalized the payment rule for the Medicare End Stage Renal Disease (ESRD) program for 2015. Payment rates will stay the same next year. However, changes to the Quality Improvement Program (QIP) system of "pay for performance" are intended to prioritize new aspects of care for ESRD patients; providers are graded on each element of the "QIP" and receive payment reductions if they don't meet Medicare's standard. This means that providers are expected to add emphasis to these new areas [...]
Insights with Jack: Who Do You Rely On?
By Jack Reynolds, DPC Board Member and Patient Ambassador This Christmas of 2014, I will have completed four decades of in-center hemodialysis. As this amount of time surviving with a kidney machine as a life partner is fairly rare, I feel that it would be a good idea to discuss or maybe vent my soul about my experience as a dialysis citizen and how it has affected my outlook on life. I plan to keep my blogs fairly short and to only touch on one or two points [...]
CMS Responses to Questions and Comments about the Dialysis Facility Compare Star Rating System
CMS thanks the community for their comments and questions about the DFC Star Rating System. All comments have been given serious consideration. This document provides responses to the questions and issues raised by the ESRD community. CMS believes that the Star Rating System will empower consumers with additional quality information. It will also encourage providers to continuously achieve higher quality care. With future releases and enhancements to the DFC website, we will continue fostering an open dialogue to facilitate providing better care for all patients receiving chronic dialysis. [...]
Response Memo: FAQs Regarding Medicare and the Health Insurance Marketplace
To: James Canavan, Center for Medicare, Centers for Medicare & Medicaid Services Spencer Manasse, Center for Consumer Information and Insurance Oversight, CMS Vicki Gottlich, Administration for Community Living Gene Coffey, Center for Medicaid and CHIP Services, CMS Janet Miller, Office of Communications, CMS Sharon Donovan, Medicare-Medicaid Coordination Office, CMS Re: Comments on “Frequently Asked Questions Regarding Medicare and the Marketplace” We appreciate that the Centers for Medicare & Medicaid Services (CMS) and the Administration for Community Living (ACL) arranged a July meeting for beneficiary advocates to discuss [...]
Statement of Dialysis Patient Citizens on CMS Announcement of Delay in Implementing Star Ratings for Dialysis Facility Compare Website
Today, Dialysis Patient Citizens received a notice from CMS announcing a three-month delay in implementing its Star Ratings Program for the Dialysis Facility Compare website. Contrary to CMS’ announcement, a delay alone is not responsive to the concerns expressed by stakeholders and certainly not to those expressed by DPC. While CMS said it was “partnering with the ESRD community,” it has instead declined to consider input on how to design patient-friendly ratings, and ignored DPC’s requests to see consumer testing materials and the geographic distribution of star assignments. [...]