News Release
Joined: 09 Dec 2003
Posts: 1
Posted: Tue Dec 09, 2003 7:58 am Post subject: GAO
--------------------------------------------------------------------------------
Inadequate Medicare Funding Causing Problems in Dialysis Facilities <
><
>At Senator Charles Grassley's (R IA) request the General Accounting Office (GAO) released a report entitled, "Dialysis Facility Problems Remain in Ensuring Compliance with Medicare Quality Standards, which found that overall dialysis care was improving. However, they did find staffing shortages and other problems which dialysis providers believe can be attributed to inadequate Medicare reimbursement. <
><
>Larry C. Buckelew, CEO of Gam
o Healthcare and Chairman of the Renal Leadership Council (RLC), the leading association of dialysis providers, said, "It is important to recognize that renal care, in which an individual's blood is artificially cleaned, is a life sustaining method of care for 300,000 Americans with kidney failure in this country. He also noted that, " the dialysis provider industry has developed dramatically over the past thirty five years both in terms of professional patient care, and more importantly in terms of improved patient outcomes." Most dialysis providers publish patient outcome data as a matter of public record. <
><
>Mr. Buckelew said, "Members of the Renal Leadership Council are committed to advancing the quality outcomes for the patients they treat under the auspices of the leading nephrologists in this country." "Appropriate doses of dialysis are now provided to 94% of patients compared to less than 75% a few years ago and anemia management has also improved, he said. "However, Mr. Buckelew stated, that while Medicare pays on average for 75% of care in dialysis facilities, members of the RLC believe that Medicare reimbursement does not represent the true cost of dialysis care." "In fact, he said, many of the problems the GAO report finds can be directly attributable to inadequate Medicare reimbursement." In the past twelve years, Medicare reimbursement for dialysis increased by only 3.6%. "As a result, at this time, Mr. Buckelew stated, "Medicare reimbursement is inadequate to allow the continued advancement of high quality outcomes, pay for new technologies and is clearly inadequate to recruit enough nurses and healthcare workers to work in the dialysis unit" <
><
>For example, the GAO reports staffing inadequacies. Mr. Buckelew points out, "because dialysis providers are the only Medicare provider without an annual inflation mechanism, we cannot compete for scarce nurses and other health workers with hospitals and other health care providers who have built-in inflation reimbursement increases." The RLC has urged the Congress to enact Medicare dialysis payment reform by adding an annual inflation formula to the current dialysis reimbursement. At this time the RLC is waiting to find out what Congress will recommend in terms of Medicare inflation increases for dialysis facilities over the next few years. <
><
>In response to the GAO's findings that 16% of patients are receiving inadequate care, Dr. Raymond Hakim, Chief Medical Office of Renal Care Group, a RLC company, and Chairman of Kidney Care Partners, a coalition of 22 renal related organizations, said, "that this is in large part due to the fact that a quarter or more of the patients each year are new to dialysis, have on average three other major co-morbidities and therefore companies have to work very hard to provide the care needed to improve their quality outcomes." Dr. Hakim went on to say, "because of the large number of uninsured Americans, particularly African Americans, and because kidney disease tends to be a "silent disease" many patients are referred to a dialysis facility without adequate medical attention or preparation." "As a result dialysis health care workers have to work hard as a team to improve patients' health outcomes as soon as they get to the dialysis unit." <
><
>Limitations on Medicare reimbursement and coverage rules by the Centers for Medicare and Medicaid Services for an anemia management drug also are responsible for the GAO's finding that some patients' anemia is not managed as well as possible, according to Dr Hakim. Lastly, Dr Hakim said, "There is no recognition in Medicare's reimbursement for dialysis centers to use improved technology to reduce error rates and improve outcomes. The Renal Leadership Council has continuously urged Medicare to cover new technologies and nutritional supplements so that providers can continue to improve care." <
><
><
>About the Renal Leadership Council<
>The Renal Leadership Council is an association representing the interests of renal dialysis providers. The RLC members provides renal replacement therapy services in over 1,350 dialysis facilities in 42 states and the District of Columbia to 110,000 individuals with End Stage Renal Disease. ESRD patients receive dialysis treatments in RLC member free- standing and hospital-based centers that are located in urban and rural areas of the country. The association was formed to represent the interests of dialysis providers in the development and implementation of public policy and to serve as a resource for Federal policy makers on national End Stage Renal Disease issues.<
><
> <
><
> <
><
>
**************************************************************************
FYI
Joined: 15 Feb 2003
Posts: 72
Posted: Tue Dec 09, 2003 9:05 am Post subject: house committees
--------------------------------------------------------------------------------
Have been notified that we have not been forgotten as the drug medicare was AWFUL and had to be pushed through.<
><
>We will be working with them after the holidays and others.......<
><
>Arlene
**************************************************************************
leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Tue Dec 09, 2003 9:42 am Post subject: Re: house committees
--------------------------------------------------------------------------------
The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) has released its Semiannual Report to the Congress.<
><
>CMS should reduce the payment rates for outpatient dialysis treatments to reflect current efficiencies and economies in the marketplace.<
><
>oig.hhs.gov/publications/...llsemi.pdf<
><
><
><
>
**************************************************************************
FYI
Joined: 15 Feb 2003
Posts: 72
Posted: Tue Dec 09, 2003 9:59 am Post subject: Committees
--------------------------------------------------------------------------------
That is why it is important to educate these committees. The greed has been recognized,but the patients need not be the ones that suffer.<
>We are in a good place.
**************************************************************************
leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Tue Dec 09, 2003 11:14 am Post subject: OIG
--------------------------------------------------------------------------------
Maybe what the OIG is saying is that the funding is adequate if the centers were to use the funds in appropriate manner. For the care of the patients.
**************************************************************************
crazy
Joined: 09 Dec 2003
Posts: 1
Posted: Tue Dec 09, 2003 12:35 pm Post subject: OIG
--------------------------------------------------------------------------------
THe OIG says that they could save 22 million a year by reducing reimbursement. Well if you do the math and assume 280,000 people are dialyzed 156 times a year that works out to about $.50 . Half a buck.<
><
>If you take the total payment to all outpatient ESRD providers and divide by # of patients and 156 it comes out to $160 that is the total per patient per treatment spending by CMS treatment and EPO. No money is made off CMS all the profit is made on private pay.<
>
**************************************************************************
talk to the hand
Joined: 09 Dec 2003
Posts: 1
Posted: Tue Dec 09, 2003 12:57 pm Post subject: my rate
--------------------------------------------------------------------------------
on my eob from CMS
for october the
eakdown per treatment is 242.42 and i have not received the eob from united healthcare. it would be crazy talk to assume every patient drops their secondary insurance for medicare. rest assured the providers are receiving more than what you just stated because there are quite a few of us who do keep our secondary plans for our medications. even with the supposedly new drug benefit that takes place in the future, a trip to the hospital would bankrupt people given that medicare only pays 80%.
**************************************************************************
Curious
Joined: 02 Feb 2003
Posts: 39
Posted: Tue Dec 09, 2003 3:58 pm Post subject: That is only a portion
--------------------------------------------------------------------------------
Most of the money comes from injectable drugs etc. Check your epo portion of the bill.
**************************************************************************
a patient
Joined: 21 Nov 2003
Posts: 6
Posted: Tue Dec 09, 2003 5:08 pm Post subject: What balonie!
--------------------------------------------------------------------------------
I am so royally sick of these articles!! Wow, this time its the RLC. I wish there was a way to simulate for this group of nephrologists what its like to be on DIE-alysis. There is so much more to dialysis than adequacy on paper. Not one of these physicians would dialyze in-center if they were stricken with kidney disease. They really need a dose of their own medicine to get the picture of what it's like to dialyze in so many of the in-center facilities. The lack of attention to professionalism and quality dialysis is so entrenched in this system it is tragic. The blindness and greed of the medical people and govt is horrifying. Grassley finally said it right when he described the skull and bones of corruption this system is about. It's sure taught me a tremendous lesson - these travesties of justice don't get solved by the usual political process - they take an extraordinary effort of exposure - well planned media and legal suits and the hand of what few honest politians there are. I for one will never give up until the victory is won. Determination will win out in the end. DEO will inch it's way to the finish line!
**************************************************************************
BRLA
Joined: 08 Nov 2003
Posts: 22
Posted: Tue Dec 09, 2003 5:42 pm Post subject: Costs
--------------------------------------------------------------------------------
Curious, you are so correct. I performed an analysis of invoices submitted to my private insurance for husband's dialysis costs for a 13-month period. (An FMC facility) Results were:<
><
># of Sessions - 168<
><
>Total Amt Billed -- $274,863.25 <
><
>Breakdown:<
><
>$100,225.00 Hemodialysis Procedures<
>$142,860.50 Epogen <
>$ 18,340.19 Other Meds/Oxygen<
>$ 12,639.69 Labs<
>$ 797.87 Supplies/Blood <
>$274,863.25 TOTAL <
