The ASN Policy Board presents the February issue of Renal Policy Express.
In This Issue...
ASN Public Policy Board Update
World Kidney Day Advocacy Effort Well Underway
Last year, the ASN Public Policy Board brought 11 nephrologists to Washington, DC for Congressional visits on World Kidney Day. These physicians were paired with patient advocates from the National Kidney Foundation and attended over 40 meetings with their Senators and Representatives. This year, the board is increasing its advocacy efforts. At least 23 nephrologists have confirmed their participation and the ASN staff is working hard to set up meetings with their congressional offices. If you are interested in participating as an ASN member, please contact Susan Owens as soon as possible at sowens@asn-online.org or 202-416-0068, and we will help to facilitate Congressional visits with your representatives.
The goals of the ASN on World Kidney Day are to raise awareness of chronic kidney disease as a public health problem, advocate for kidney disease research, and stress the importance of standards of care for kidney disease patients. The board will also be publishing an editorial in the Journal of the American Society of Nephrology, utilizing our public relations firm for press activities including a radio spot and planning a congressional reception with the National Kidney Foundation. For more information, please contact Susan Owens at sowens@asn-online.org.
ASN Public Policy Board Adds New Member
The ASN Public Policy Board is proud to announce the addition of Neil Powe, MD, MPH, MBA, FASN. Dr. Powe will replace Brian Pereira, MD, MBA, who has resigned from the board due to his commitments with AMAG Pharmaceuticals, Inc.
Dr. Powe is a Professor in the Department of Medicine at the Johns Hopkins University School of Medicine, Director of the Welch Center for Prevention, Epidemiology and Clinical Research, and Professor of Epidemiology and Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health. He is the principal investigator of the End-Stage Renal Disease Patient Outcomes Research Team (Choices for Health Outcomes in Caring for ESRD or CHOICE) and the ESRD Quality (EQUAL) Study funded by the Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health (NIH). He received his medical degree from Harvard Medical School, a master of public health degree (MPH) from Harvard School of Public Health, and a master of business administration (MBA) from the University of Pennsylvania. He completed his residency and fellowship at the Hospital of the University of Pennsylvania. Welcome, Dr. Powe!
National Institutes of Health
Bush Administration Releases Fiscal Year 2009 Budget
On February 4, 2008, the Bush Administration released its Fiscal Year (FY) 2009 budget. The budget request includes $29.230 billion in discretionary budget authority through the Labor-HHS-Education Appropriations for the National Institutes of Health (NIH). This is equal to the FY 2008 appropriations and represents the sixth consecutive year that the NIH budget has failed to keep pace with biomedical inflation. The ASN participated in a special invitation budget briefing with NIH Director Elias Zerhouni, MD, and his senior staff.
You can read a summary released by NIH of the President’s FY 2009 budget here.
Consequently, the Ad Hoc Group for Medical Research, of which ASN is a member, released a statement condemning the President’s FY 2009 budget proposal. You can view that statement here. The Ad Hoc Group has proposed $31.1 billion for NIH, an increase of $1.9 billion over the FY 2008 funding level.
Executive Committee of Ad Hoc Group Meets with Senior NIH Directors
On January 10, 2008, the executive committee of the Ad Hoc Group for Medical Research met with four senior directors from the NIH to discuss appropriations funding and research and clinical trial priorities. Griff Rodgers, MD, Director of The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), made a presentation to the group, which you can view here. The meetings were attended by Paul Smedberg, ASN Director of Policy & Public Affairs, who serves on the executive committee.
NIDDK Offers Implementation Planning (U34) Grant
NIDDK supports investigator-initiated, multi-center clinical studies through a two-part process that includes an implementation planning (U34) grant. The U34 planning grant is designed to: (1) permit early peer review of the rationale for the proposed clinical study; (2) permit assessment of the design/protocol of the proposed study; (3) provide support for the development of a complete study protocol and associated documents including a manual of operations and (4) support of the development of other essential elements required for the conduct of a clinical study. Completion of the required products of a U34 grant is a prerequisite for submission of a multi-center clinical study cooperative agreement (U01) application, which will support the actual conduct of the study.
The announcements can be found at: U34 (http://grants.nih.gov/grants/guide/pa-files/PAR-08-057.html) and U01 (http://grants.nih.gov/grants/guide/pa-files/PAR-08-058.html).
The first submission date is March 19, 2008.
National Diabetes Education Program Announces Strategic Plan
The National Diabetes Education Program (NDEP) has announced a three-year plan focused on raising awareness of its available diabetes control and prevention products among people with diabetes, people at risk for developing diabetes, and health care professionals. Diabetes (along with hypertension) is one of the two main causes of kidney disease. NDEP is jointly sponsored by the NIH and the Centers for Disease Control and Prevention. You can visit their website at: http://ndep.nih.gov/.
Flexible Grant Submission Process Offered for NIH Study Section Members
NIH has announced an alternate plan for submission and review of research grant applications as a reward to standing study section members. This program, which will begin on February 5, 2008, allows for a continuous submission process. All applications submitted under this program will be reviewed within 120 days. An application is eligible for the continuous submission cycle as long as one principal investigator is a standing study section member. This policy applies to R01, R21, and R34 grants.
For more information, please visit: http://grants1.nih.gov/grants/guide/notice-files/NOT-OD-08-026.html.
NIH Voluntary Public Access Policy Now Mandatory
This policy applies to "…any peer-reviewed articles that arise, in whole or in part, from direct costs funded by NIH, or from NIH staff, that are accepted for publication on or after April 7, 2008," under the Consolidated Appropriations Act of 2007 (PL 110-161). It requires that an electronic version of the above-mentioned manuscripts be submitted to the National Library of Medicine’s PubMed Central upon acceptance for publication. They shall then be made publicly available no later than 12 months after the official date of publication.
You can learn more here: http://grants.nih.gov/grants/guide/notice-files/NOT-OD-08-033.html.
Regulatory Issues
Legislation Being Crafted to Delay Payment Cuts for Doctors
House and Senate aides are working to craft Medicare legislation that will center on an 18-month-long halt to a 10.6 percent cut to Medicare’s physician payment rates now scheduled for July 1, 2008, according to an article in the January 17, 2008 issue of CQToday. The cuts are mandated by Medicare cost-containment formulas and have been delayed by Congress several times since their introduction in 2002. ASN continues to support a long-term legislative solution to fix the Sustainable Growth Rate problem for Medicare physician reimbursement.
MedPAC Holds Meeting: "Adequacy of Outpatient Dialysis Payments"
On Thursday, January 10, 2008, the Medicare Payment Advisory Commission (MedPAC) held a public meeting to examine the "Adequacy of Outpatient Dialysis Payments." At the meeting, the Commissioners voted unanimously to approve a recommendation to Congress to increase the composite rate by 1.0 percent in 2009. The recommendation also reiterates that Congress should implement a quality incentive program for facilities and physicians who treat dialysis patients.
Prior to the vote, Nancy Ray, MedPAC’s end stage renal disease (ESRD) senior policy analyst, gave a presentation which you can view at http://www.medpac.gov/transcripts/0108_dialysis_NR_pres.pdf. According to her presentation, access to care remains good and there has been an average of five percent growth per year in the number of facilities during the last decade. Ms. Ray noted few facility closures in 2006 and linked the closures that did take place to either small size or low profitability. For a summary written by Patton Boggs, LLP for the Kidney Care Partners, of which ASN is a member, click here.
Medicare Spending Increased by 18.7 Percent in 2006
According to researchers from the National Health Statistics Group in the Centers for Medicare & Medicaid Services Office of the Actuary, Medicare spending rose 18.7% in 2006. Most of the increase was a result of the program’s prescription drug benefit. This increase in spending was 9.4 percentage points higher than the increase in spending that occurred in 2005 and the fastest rate of growth since 1981. Spending is not expected to grow as rapidly in subsequent years, because the drug benefit spending will have been added to the program and the initial spending increase will have been accounted for.
To listen to the media briefing regarding the spending increase, please visit: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2467.
CMS Announces New Quality Measures
The Medicare, Medicaid, and SCHIP Extension Act of 2007, signed into law by President Bush on December 29, 2007, authorized the continuation of the Physician Quality Reporting Initiative (PQRI) for 2008. It includes 119 quality measures. The 2008 PQRI offers bonus payments of 1.5% of total allowed charges for covered services payable under the Physician Fee Schedule to physicians who submit data on the quality of covered professional services. Examples of measures included for 2008 are "Plan of Care for ESRD Patients with Anemia" and "Chronic Kidney Disease Blood Pressure Management."
For more information, please visit: http://www.cms.hhs.gov/PQRI. Click on “Measures/Codes” on the left to view all 119 quality measures. The PQRI website has been recently reorganized to facilitate access and navigation.
Miscellaneous News
National Renal Alliance Files Civil Complaint against Private Insurance Provider
In mid-January, 2008, National Renal Alliance filed a civil complaint against private insurance provider Blue Cross Blue Shield of Georgia (BCBSGa) for allegedly singling out dialysis benefits and cutting out-of-network reimbursement to the dialysis provider’s Georgia clinics. You can read the complaint here: http://www.nashvillepost.com/documents/NP_pdfs--legal/NRA_BlueCross_Complaint.pdf. Currently, private insurance companies, such as BCBSGa, pay for the first 30 months of a patient’s dialysis treatment. Medicare takes over after that, albeit at a much lower rate than what the private insurer pays. The National Renal Alliance was founded 2002 and owns and operates 43 dialysis clinics in the United States.
We hope that you have enjoyed this version of ASN's Renal Policy Express. Please refer any questions or comments regarding this newsletter to policy@asn-online.org.
Paul Smedberg, Director, Policy and Public Affairs
Susan Owens, Senior Policy Coordinator
