Paul's Message
Dear ASN Members:
One important issue I'd like to discuss is that double digit funding increases for biomedical research have come to an abrupt end. The House Labor, Health and Human Services, Education and Related Agencies (LHHS) Appropriations Subcommittee and full Appropriations Committee marked up their FY 2005 spending bill, which includes a 2.8 percent increase for the National Institutes of Health (NIH). The LHHS subcommittee passed their version of the bill by a vote of 18 to 0 after defeating an amendment by Rep. David Obey (D-WI), the ranking member on the full committee, to provide additional funding for health, education, and labor programs, offset by a reduction in the tax cuts passed in 2001 and 2003 for individuals with annual incomes above $1 million.
For NIH, the bill provides a fiscal year (FY) 2005 funding level of $28.441 billion, an increase of $782 million (2.8 percent) over FY 2004. This is equal to the Administration's FY 2005 request. All institutes and centers – including the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) - are funded at the Administration's requested levels.
Senate Appropriations Committee Chairman Ted Stevens (R-AK) cancelled planned (Senate) subcommittee markups of nine FY 2005 spending bills, including the LHHS bill, after Senate Democrats rejected the chairman's demand that they agree to time limits on floor debate on the bills before the subcommittees or full committee could consider them. It is not known when the Senate will attempt to deliberate and mark up their version of the LHHS Appropriations bill. Given the national election, lack of Senate movement and the dwindling number of legislative days until the end of the FY04 fiscal year September 30, lawmakers in both chambers are making plans for an FY05 omnibus bill. Click here to read the House LHHS Appropriations Bill Summary.
Of primary concern to the ASN™ is the still uncertain outlook for funding for NIH and NIDDK for the 2005 fiscal year, which begins October 1. ASN™ has joined with more than 200 medical and health organizations advocating for a 10 percent increase in NIH funding for FY 2005, and we are pushing for a larger NIH allocation in the Senate bill. Click here to read the letter and the organizations who have signed on.
Despite its current funding concerns, NIH continues to strengthen its public health campaign, through several outlets. The National Kidney Disease Education Program (NKDEP) began its first national effort to call attention to the severity of kidney disease and the importance of testing those at high risk, particularly African Americans. "It's critical that we get in front of this growing epidemic. People's lives don't have to be devastated by kidney failure," said Thomas Hostetter, M.D., director of NKDEP, which is an initiative of the National Institutes of Health (NIH). That's the aim of NKDEP's “You Have The Power To Prevent Kidney Disease” campaign. It stresses three key messages: 1) know if you are at risk, 2) have your kidneys tested if you are at risk, and 3) kidney failure can be slowed or prevented if kidney disease is detected early. This national effort builds upon pilot education campaigns conducted in Atlanta, Baltimore, Cleveland and Jackson, MS, over the past year. More than 30 public agencies and private organizations were involved in the pilot programs' development and are supporting the initiative's national implementation. Click here to learn more about the ”You Have The Power To Prevent Kidney Disease” campaign.
NIH also recently announced the launch of an expanded health information website. The expanded site now offers links to a wider range of NIH's valuable resources and features colorful images to highlight an intriguing range of useful features. Visitors can still access the popular "A to Z" listing of health topics, browse topics by body location/systems, or use the main "Search" box.
As you can tell, the ASN and our Policy and Public Affairs Committee continue working hard to make sure that medical policy is in the best interest of you and yours patients. As always, please email me, if you have suggestions that enable us to assist you.
Sincerely yours,
Paul C. Smedberg
Director, Policy and Public Affairs
Senate Pay-for-Performance Bill Introduced
On June 23, 2004, Senator Max Baucus (D-MT), a ranking member of the Senate Finance Committee introduced "The Medicare Quality Improvement Act of 2004", which would build on the initiatives included in the Medicare bill to link payment with quality of care in the Medicare program.
Following the recommendations of MedPAC (Medicare Payment Advisory Commission), the bill would establish a pay-for-performance system for Medicare Advantage and End Stage Renal Disease (ESRD) programs. Plans and providers delivering the highest quality care, as well as those who saw improved quality from one year to the next, would receive higher payments than those plans and providers that either were not high-quality and who did not improve.
"Giving healthcare providers a reason to make sure their service is top-notch will save taxpayer dollars in the long run,” Baucus said. "This legislation is a step towards raising the standard of care that Medicare beneficiaries receive."
In addition to establishing new programs for Medicare Advantage and ESRD, the bill calls for a roadmap to creating pay-for-quality programs across all of Medicare.
The Medicare Quality Improvement Act will also allow more resources to be allocated to improve healthcare services in the Medicaid program. The legislation authorizes the hiring of five new personnel to work on quality improvement for Medicaid at the Centers for Medicare and Medicaid. It also looks at ways to improve quality of care and reduce costs for the dual-eligibles - those who are enrolled in both Medicare and Medicaid - many of whom represent the costliest beneficiaries in both programs.
ESRD Modernization Bill Introduced in Senate
Senator Kent Conrad (D-ND) recently introduced the ESRD Modernization Act of 2004 (S. 2614). The ESRD Modernization Act seeks to establish an annual update framework for the ESRD composite rate under the Medicare ESRD program. The bill also directs the Secretary of Health and Human Services (HHS) to establish demonstration projects to: 1) increase public awareness about the factors that lead to chronic kidney disease, how to prevent it, how to treat it, and how to avoid kidney failure; and 2) enhance surveillance systems and expand research to better assess the prevalence and incidence of chronic kidney diseases.
In 1972, Congress committed to providing ESRD patients with coverage for their lifesaving therapy through the Medicare program. In 1983, Congress implemented the first Medicare Prospective Payment System (PPS), known as the “composite rate,” for reimbursing dialysis providers. Medicare's ESRD program continues to play a vital role in ensuring access to high quality, lifesaving therapy for patients with kidney failure. Better care for patients means better quality of life, improved rehabilitation, fewer medications, and fewer hospitalizations.
Congress should act immediately to provide an annual update mechanism for the ESRD composite rate, just as it has done for all other Medicare prospective payment systems. The ESRD composite rate is the only Medicare PPS without an annual update mechanism to adjust for changes in input prices and inflation. MedPAC recommended that Congress provide for such an update in its 2000 annual report.
Congress must ensure the economic stability of the ESRD Program. It is essential that the ESRD program provide the appropriate incentives for continued improvements in the quality of care patients receive. For example, CMS has recognized that the type of dialysis access patients receive dramatically impacts the quality of care. Payment policies should promote the most efficient settings for providing these access procedures and the most effective access for each patient. Equally important is considering how to promote improvements in the quality of care. Click here for more information.
