Dialysis Patient Citizens News
Is This the Future of ESRD Care? A New Program Goes the Extra Mile for Dialysis Patients
By, Jackson Williams, Government Affairs Director for Dialysis Patient Citizens For more than a decade, officials in Washington, DC have been experimenting with ways to reorganize Medicare to deliver better care at lower costs. Several of these “demonstration projects” have involved ESRD patients. Now, the largest such program for dialysis patients has kicked off at 13 locations across the U.S. It’s called the ESRD Seamless Care Organization, or “ESCO,” model. This article describes what one of these projects, Philadelphia-Camden Integrated Kidney Care, is doing to improve care for [...]
DPC Submits Comments to Chronic Care Working Group Re: Medicare Advantage
Hon. Johnny Isakson Hon. Mark Warner United States Senate Washington, DC 20510 Re: Comments to the Chronic Care Working Group Dear Senators Isakson and Warner: As America’s largest patient-led organization representing persons with end-stage renal disease, with over 28,000 members, Dialysis Patient Citizens (DPC) works to improve quality of life for dialysis patients through education and advocacy. We are grateful to the Working Group for its focus on how chronic illness care could be improved for patients with ESRD. As you know, ESRD patients represent a small [...]
Paper from Senate Group Focuses on Improving Access to Healthcare
A recent document released by the Senate Chronic Care Working Group contains several policy proposals relating to the care of end-stage renal disease (ESRD) patients. The working group was formed last year under by Senate Finance Committee as a way to explore potential bipartisan policy changes to improve health care. DPC was pleased to see that committee discuss many of our our policy priorities including: dialysis patient access to Medicare Advantage Plans, Telehealth for dialysis patients and the desire to make the successful Special Needs Plans permanent [...]
DPC Mourns the Loss of Board Member
Dialysis Patient Citizens was saddened to learn of the recent passing of board member Nance Lehman. Nance was a tremendous advocate for ESRD patient across the country and especially in her home state of Montana. Nance met with legislators in Washington D.C. on numerous occasions and was known to move legislative staff with her compelling stories. Most recently, Nance represented the patient perspective as a voting representative of Kidney Care Partners (KCP). Nance was committed to creating a better policy environment for ESRD patients across the country. [...]
2015 Year in Review
Happy New Year! In 2015, DPC leadership and its strong patient advocacy efforts at the state level fought to: prevent dramatic cuts to dialysis funding in Alabama and Illinois and preserve charity payments for dialysis patient premiums. Other highlights include: The opportunity for DPC CEO Hrant Jamgochian and board member Bob Lee to testify in front of the Oregon insurance commissioner on the discriminatory language found in two private insurance plans that would limit coverage for ESRD patients. The commissioner ruled against the language. DPC board member [...]
DPC Urges CMS to Prioritize Patient Access
Last month, DPC sent a letter commenting on the “Notice of Benefit and Payment Parameters for 2017” proposed rule. This annual rule by the Centers for Medicare and Medicaid Services (CMS) contains proposed changes to the exchange plan coverage of the Affordable Care Act. DPC’s letter focuses on the importance of insurance coverage and network quality for end-stage renal disease (ESRD) patients. One issue the letter comments on pertains to network adequacy. Network adequacy describes an insurance plan’s ability to provide a sufficient amount of in-network providers [...]
RE: CMS–9937–P: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017
Andrew Slavitt Acting AdministratorCenters for Medicare and Medicaid Services 7500 Security BoulevardBaltimore, MD 21244RE: CMS–9937–P: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017Dear Acting Administrator Slavitt,On behalf of the more than 430,000 patients who rely upon dialysis services, we appreciate the opportunity to comment on the “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017” Proposed Rule (Proposed Rule). We strongly encourage the Centers for Medicare and Medicaid Services (CMS) to protect the rights of [...]
Medicaid-Eligible Dialysis Patients Not Fully Informed of Treatment Options, Survey Finds
End-stage renal disease (ESRD) patients who receive Medicaid are less likely to be informed of home modality and transplantation options than patients covered by Medicare or commercial insurance, according to survey research DPC released earlier this month. DPC recently partnered with Baxter to facilitate a panel discussing these disparities at the National Black Caucus of State Legislators (NBCSL) Conference in Los Angeles, California. The DPC survey found that while about 74 percent of ESRD patients overall are informed about the option of home hemodialysis, there is an information [...]
DPC Submits Feedback to CMS on Proposed Additions to Dialysis Facility Compare Tool
The Centers for Medicare and Medicaid Services (CMS) recently announced plans to add more measures to their Dialysis Facility Compare (DFC). The DFC is an online tool that allows users to search and compare dialysis facilities within a certain area based on ratings and certain measures. The added measures would examine fluid management, the rate of blood stream infections in in-center hemodialysis patients and pediatric peritoneal dialysis adequacy. Data collected through the Consumer Assessment of Healthcare Providers & Systems In-Center Hemodialysis (CAHPS ICH) surveys would also be [...]
CMS Updates Policies and Payment Rates for End-Stage Renal Disease Facilities for 2016
On October 30, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished after January 1, 2016. The agency said the “ESRD final rule is one of several rules for calendar year 2016 that reflect a broader Administration-wide strategy to provide quality care at lower cost by improving ways to deliver care, pay providers, and use information.” This final rule also includes changes to [...]
CMS to Expand Prior Authorization of Transportation Services to Six More States
The Centers for Medicare and Medicaid Services (CMS) will begin expanding a prior authorization model for non-emergency ambulance transportation for dialysis patients into six states: Maryland, Delaware, the District of Columbia, North Carolina, Virginia and West Virginia. The program expansion will begin on January 1, 2016 and requires ambulance providers in those states to obtain documentation from physicians prior to beginning service. CMS plans to reach out to ambulance providers and Medicare beneficiaries about the program through educational materials. This model was originally implemented in New Jersey, Pennsylvania and [...]
Bipartisan Budget Deal Includes Lower Premium Hikes for Medicare Part B
Earlier this week, the President signed a two-year bipartisan budget deal that changes the premium and deductible amounts for Medicare Part B plans. ESRD patients whose Medicare premiums are not deducted from their Social Security checks were initially facing a premium increase of 50 percent to $159 a month, but now will pay around $120 a month. The lower rate was established through a loan from the Treasury Department to the Supplemental Medical Insurance Trust Fund. The difference will be made up through monthly $3 repayment fees added [...]
DPC and Patient Advocates Win Oregon Ruling on Discriminatory Insurance Practices
DPC and kidney advocates won a ruling from the Oregon insurance commissioner against discriminatory language in an insurance policy limiting coverage for ESRD patients. Bob Lee, a DPC Patient Ambassador and ESRD patient, and Hrant Jamgochian, Executive Director of DPC, attended a public hearing on the topic in Salem and presented testimony on behalf of DPC’s membership. The insurance commissioner ruled: Insurers are prohibited from discriminating based on health factors. Insurers may not require enrollment in Medicare, regardless of member entitlement or eligibility. Insurers providing information to [...]
Open Enrollment Begins For 2016 Insurance Coverage
This week begins the open enrollment period for 2016 coverage. The health insurance marketplace lists coverage options for patients who do not have an insurance plan through an employer, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or a private plan. Enrollment can be done by phone, online, through a paper application and in person. Open enrollment will run through January 31, 2016.
DPC Urges Department of Insurance to Protect Dialysis Patient Access in Oregon
Ms. Laura Cali, Insurance Commissioner Department of Consumer & Business Services Insurance Division PO Box 14480 Salem, Oregon 97309-0405 Re: Discrimination against end-stage renal disease patients by Regence health plan Dear Commissioner Cali: With 28,000 dialysis patient members, Dialysis Patient Citizens (DPC) is the nation’s largest patient-led organization representing individuals with end-stage renal disease (ESRD). I am writing on behalf of Oregon’s 3,821 dialysis patients, asking that you ensure that they are treated equitably by the Regence health insurance plan. Regulatory filings by this issuer indicate that its [...]
DPC Calls on Regulators to Investigate Insurer’s Renal Care Coverage Limitations
Kidney advocates are reacting to an alarming trend in the commercial insurance industry: insurers are increasingly writing language into policy documents that attempt to exclude or limit coverage of renal care. DPC is alerting regulators at both the state and federal levels to the harm these limitations could have on patients and asking them to enforce the numerous laws that prohibit health plans from discriminating against people with ESRD. Federal law guarantees that ESRD patients may keep their private insurance coverage for up to 30 months before [...]
DPC, Kidney Patient, Testify at Hearing on Surprise Medical Bills
DPC Policy Director Jackson Williams and Pittsburgh kidney patient Janice Nathan were among witnesses at a hearing held by Pennsylvania’s insurance commissioner on “surprise medical bills.” These are bills received from physicians who are outside of an insurer’s provider network even though they work inside facilities that are in-network. Janice Nathan’s primary care doctor recommended that she receive a cardiac stress test. Ms. Nathan checked her insurer’s provider directory and found an in-network facility to get the test. But when she received a cardiologist’s bill for $325—much [...]
New ACO Model Focuses on ESRD Patient Care
The Centers for Medicare & Medicaid Services (CMS) has announced the participants for the Comprehensive ESRD Care (CEC) Model, a new accountable care organization (ACO) model designed specifically for ESRD patients. ACOs are groups of physicians and other health care providers who collectively take on responsibility for the quality and cost of care for a population of patients. In the CEC Model, dialysis facilities, nephrologists and other providers have formed ESRD Seamless Care Organizations (ESCOs) to coordinate care for ESRD beneficiaries. ESCOs will be financially accountable for quality [...]
DPC Assists Grassroots Efforts to Secure Level Medicaid Funding in Alabama
DPC has been hard at work on the state level fighting to ensure continued access to quality patient care, most recently in Alabama and North Carolina. In Alabama, patients fought to maintain Medicaid funding for outpatient dialysis, which the state was considering moving to local hospitals instead, in a potential effort to close the state budget shortfall. Patient advocates quickly took action and contacted their state legislators to encourage alternative revenue generating measures to close the budget gap as opposed to eliminating Medicaid funding. Thankfully, the state [...]