MEDICARE REIMBURSEMENT POLICY LIMITS ADOPTION OF THIS
NEW MODALITY OF TREATMENT
- Current reimbursement limits hemodialysis generally to three times a week. This
   precludes patients from enjoying the great benefits of more frequent dialysis.
- Current reimbursement creates a financial disincentive for facilities to adopt daily
  dialysis, even though its patient benefits are well established.
- Although direct reimbursement to dialysis facilities must be increased to allow greater
  access to more frequent dialysis, overall costs to Medicare would be reduced
  because of fewer hospitalizations and reductions in the use of intravenous drugs.
- On March 25th, 2003, the chief actuary noted that in the last year Medicare spending on
  hospitalization was up 10%. More frequent dialysis is one way that this can be
  reduced for ESRD patients.
- The CMS/NIH study will take several years to produce results.
LEGISLATIVE SOLUTION
- The Kidney Patient Daily Dialysis Quality Act of 2003: Congressman Jim
   McDermott (Dem., Washington) and Congresswoman Jennifer Dunn (Rep.,
   Washington) introduced H.R. 1004 on February 27, 2003.
- Key Elements of HR1004:
   > Establishment of a payment rate for the new modality of daily hemodialysis (and
     equivalent treatments requiring blood access), independent of location and that
     takes into account the cost of more frequent dialysis, benefits to patient wellbeing,
     and the reduced total medical costs. Rates will be defined for:
    >Ongoing daily dialysis at home or in-center
    > Training of patients for hemodialysis at home
    > Identical reimbursement rates for Method I and Method II billing.
    >Empowerment of the Secretary of CMS to define standards of care for the new
    modality in consultation with the nephrology community.
    >Clinical judgment of the physician working with the individual patient to decide
    who is a “qualified individual”
    >More frequent hemodialysis is defined as hemodialysis sessions or equivalent
    therapy requiring blood access performed at least 5 times per week.
ENDORSEMENTS
HR 1004 is supported by the National Kidney Foundation and the American Nephrology
Nurses Association. The Renal Physicians Association “supports enactment of legislation
requiring CMS to immediately provide reimbursement for more frequent dialysis sessions
while waiting the results of clinical trials and/or demonstration projects in this area.”  The
American Association of Kidney Patients in its statement concerning daily hemodialysis
options encourages “the development of new treatment methods which will result in
improved quality of care and clinical outcomes for kidney patients.”
All studies have shown both short daily and long nightly dialysis are significantly better for patients than conventional three times a week dialysis. The best argument for daily dialysis is that patients who have experienced it continue to write glowing testimonials about the benefits they have experienced despite the extra work.
This treatment should be made an option available to all suitable ESRD patients.