The ASN Policy Board presents the July issue of Renal Policy Express.
In This Issue...
- Regulatory Issues
This section includes information on a recent Ways & Means Health Subcommittee hearing, immunosuppressive drug coverage, physician profiling, the Physician Quality Reporting Initiative, physician spending, and new CMS Organ Transplant Center Conditions of Participation.
- National Institutes of Health/Appropriations Update
The 2008 Appropriations Bills are making their way through Congress — an update is given here.
- Other
In this section, you can read about dialysis care and the need for physician autonomy and the National Quality Forum ESRD Steering Committee.
1.Regulatory Issues
Ways & Means Health Subcommittee Holds Meeting on Anemia Management
The House Ways & Means Health Subcommittee, chaired by Pete Stark (D-CA), held a public hearing on June 26, 2007 to address safety concerns regarding the dosing of erythropoiesis stimulating agents (ESAs), variations in the utilization of ESAs across providers, and reimbursement issues. It was attended by Paul Smedberg and Susan Owens of the ASN Staff. You can read more about the hearing here.
The witnesses were:
• The Honorable Donna M. Christian-Christensen, MD, a Delegate to Congress from the United States Virgin Islands; Read her testimony here.
• Leslie V. Norwalk, Acting Administrator at the Centers for Medicare and Medicaid Services (CMS); Read her testimony here.
• Robert A. Vito, Regional Inspector General for the Office of Evaluation and Inspections, U.S Department of Health and Human Services (DHHS); Read his testimony here.
• John K. Jenkins, MD, Director, Office of New Drugs, Center for Drug Evaluation and Research at the Food and Drug Administration (FDA); Read his testimony here.
• Ajay K. Singh, MD, Clinical Director, Renal Division, Director, Dialysis Services, Associate Professor of Medicine, Brigham and Women's Hospital (CHOIR study); Read his testimony here.
• Kris Robinson, Executive Director and CEO, American Association of Kidney Patients (AAKP); Read her testimony here.
• and Alan S. Kliger, MD, President, Renal Physicians Association (RPA); Read his testimony here.
Many of the representatives suggested that Medicare should move toward a bundled payment system for anti-anemia drugs, but should avoid a “one size fits all” approach, given the variations among kidney disease patients. Dr. Kliger, in his testimony on behalf of the physician community, said “We believe it is of paramount importance to maintain the physician's autonomy and ability to exercise clinical judgment in prescribing for the individual patient.”
You can read the Kidney Care Partners (KCP) summary here. The ASN will be submitting a letter to the House Ways & Means and Senate Finance Committees.
Immunosuppressive Drug Coverage
The American Society of Nephrology recently joined with its colleagues in the Immunosuppressive Drug Coalition to lobby Congress in support of legislation that would extend Medicare Part B coverage of immunosuppressive medications for transplant recipients. This legislation was introduced in the 109th Congress as H.R. 2051 and had two dozen co-sponsors. The Coalition sent a letter to these former co-sponsors, asking them to again support this legislation. You can read this letter here. This year the bill is sponsored by Representatives Camp and Stark. The Coalition also met with several Congressmen to garner support for the legislation. They targeted the Congressional Black Caucus, the Congressional Kidney Caucus, the Senate Finance Committee, the Ways & Means full Committee and Health Subcommittee, and the Energy & Commerce full Committee and Health Subcommittee.
Currently, immunosuppressive drugs for transplant recipients are only covered by Medicare for 36 months post transplant unless the kidney recipient is eligible for Medicare due to age or disability. Many kidney recipients must find other sources of coverage for the medications that are necessary to help prevent rejection of the transplant. This legislation would extend Medicare Part B for coverage of immunosuppressive medications only; no other Medicare benefits would be provided three years post transplant. Medicare would be the secondary payer after this period, so individuals who have group health coverage with this benefit would continue to receive it through their group plan.
Physician Profiling
According to a recent report and testimony to Congress by the Government Accountability Office (GAO), Medicare could start comparing resource use among doctors as soon as 2008. This comparison has also been referred to as “physician profiling.” The Centers for Medicare & Medicaid Services would use Medicare claims and utilization statistics to determine how doctors compare with each other in terms of volume and intensity of services. Doctors and physician groups would then receive reports outlining how much care they provide for particular patient conditions in relation to their colleagues. The goal of this program is to convince doctors who bill for a relatively large volume of services to adjust their treatment patterns to match his or her peers more closely.
Physician Quality Reporting Initiative
The Physician Quality Reporting Initiative (PQRI) provides a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals my earn a bonus payment, subject to a cap of 1.5% of total allowed charges for covered Medicare physician fee scheduled services, for successfully reporting a designated set of quality measures for claims with dates of service between July 1 and December 31, 2007.
The Centers for Medicare & Medicaid Services (CMS) has developed a Tool Kit for the 2007 Physician Quality Reporting Initiative, which began on July 1, 2007. The Tool Kit will assist eligible professionals with successful reporting. This Tool Kit consists of some existing educational resources plus new measure-specific worksheets designed to walk the user step-by-step through reporting for each measure.
To access the Tool Kit, click here and scroll down to the PQRI Tool Kit tab.
The Tool Kit consists of the following:
• 2007 PQRI Physician Quality Measures
• 2007 Coding for Quality Handbook
• 2007 Code Master
• MLN Matters Article 5640 — Coding & Reporting Principles
• Data Collection Worksheets
The Congressional Budget Office (CBO) Finds Reason for Rising Physician Spending
A recent study by the CBO, released June 7, 2007, concluded that growth in the volume and intensity of services, rather than payment rates, caused escalated Medicare spending on physicians during the last several years. The study found that the quantity of services that physicians provided between 1997 and 2005 increased by 39.4%, while Medicare's per-beneficiary spending on physicians' services increased by 34.5%. The data used for the study involved 2.7 million beneficiaries, with an average of 300,000 beneficiaries per year, and 27 procedures per beneficiary. For more details, click here.
New Conditions of Participation for Organ Transplant Centers Take Effect
As of June 28, 2007, all hospital transplant centers currently approved for Medicare participation are required to submit a request for new approval under the Conditions of Participation established by the new regulation that was issued by the Centers for Medicare and Medicaid Services (CMS) on March 30, 2007. The request must be submitted to CMS by December 26, 2007. If an Organ Transplant Center does not submit a request for approval under the new Conditions of Participation by December 28, 2007, CMS will conclude that the center no longer desires Medicare participation and will begin the process to withdraw Medicare approval. For more information, please click here.
2.National Institutes of Health/Appropriations Update
Fiscal Year (FY) 2008 Appropriations Update
In late June, the Coalition for Health Funding, of which ASN is a member, submitted a letter to House members urging a vote in favor of the Labor-HHS-Education Appropriations bill, which you can read here. On June 28, the Chairman of the House Ways and Means Committee, Congressman Dave Obey (D-WI), held a meeting with the groups who signed this letter to express his gratitude for our support and to encourage even greater advocacy efforts in July to garner enough votes to avoid a Presidential veto of the bill. This meeting was attended by Susan Owens from the ASN.
The bill received unanimous bipartisan support from the Labor, Health and Human Services and Education Appropriations Subcommittee on June 19, 2007 and provides a modest, 4.8 percent overall increase for programs in the bill, most of which have experienced significant cuts, lost purchasing power, or both over the past three years. This includes $29.9 billion for the National Institutes of Health —an increase of $1 billion (3.5 percent) over the Fiscal Year (FY) 2008 level and $250 million over the level in the House Subcommittee bill approved June 7, 2007 — and a $10 million increase for the Agency for Healthcare Research and Quality (AHRQ).
The full Senate Appropriations Committee approved the draft FY 2008 spending bill on June 21, 2007. The Senate version of the spending bill included a provision to expand the number of embryonic cell lines available for federally funded research. Similar legislation was vetoed by President Bush on June 20, 2007.
After the bill passes its respective bodies, a conference committee will convene to reconcile the differences between the Senate and House versions of the bill.
Congressional Language
Earlier this year, ASN proposed language for the Senate Subcommittee on Labor, and Health and Human Services and Education (LHHS) Appropriations bill. When the text of the bill on was released in late June, we were pleased to find that our submitted language for the National Institutes of Health was included. We submitted suggestions for the National Heart, Lung, and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases. You can view our language under “kidney disease” in these sections of the Appropriations bill here.
3.Other
JASN Article Addresses Dialysis Care and Physician Autonomy
An article in the July issue of the Journal of the American Society of Nephrology (JASN) addresses the changing landscape of dialysis care in the United States, including industry consolidation and a diminishing workforce. It also discusses physician autonomy and the relationship between the nephrologist and the dialysis patient. The article states, “If the nephrologist becomes consumed with simply conforming to process and meeting laboratory quality metrics…then there is a real danger that the nephrologist will lose sight of the patient as an individual.” The lead author of the article, Dr. Jonathan Himmelfarb, is the Chair of ASN's Public Policy Board.
National Quality Forum (NQF) ESRD Steering Committee Report
On June 18, NQF held the first meeting of the ESRD Steering Committee. Each of the work groups — Anemia, Dialysis Adequacy, Vascular Access & Mineral Metabolism, and Patient Education, Satisfaction, Mortality, Influenza — identified similar measures and began to evaluate candidate measures. NQF staff will continue to compile measure evaluation materials, and the work groups will have at least one conference call to continue measure evaluation. Work groups will finalize conclusions about whether measures meet the criteria at the July 9-10, 2007 meeting. You can read more about NQF here.
We hope that you have enjoyed this version of ASN's Renal Policy Express. Past issues will be archived on the ASN website for your reference. Please refer any questions or comments about material from this newsletter to policy@asn-online.org.
Paul Smedberg, Director, Policy and Public Affairs
Susan Owens, Policy and Public Affairs Coordinator
