The past 12 months have been busy for the renal care industry –– passage of new legislation, controversy over dialysis patients in ACA health exchanges, and some positive steps: Lower mortality rates for ESRD patients.

In the card game Bridge, bidding “No Trump” means you have a hot hand––and you expect to win without a favored suit, like Hearts or Diamonds. A bit risky, but the rewards are higher.

Indeed, Donald Trump became the hot hand on Nov. 8, pulling out all the campaign stops in 2016 and beating Hilary Clinton in a close election.

Already, people are worried about the fate of 20 million Americans enrolled in Affordable Care Act plans. The ACA has been a target of Republicans as well as Trump on the campaign trail. The Marketplace exchanges are clearly exhibiting growing pains, as health plans have pulled out because of high beneficiary costs. Time will tell if the insurance mandate survives or gets major surgery.

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Controversy erupted this year as dialysis providers were accused by health care plans of “steering” patients into more lucrative ACA plans and bypassing Medicare and Medicaid plans, where payment rates are fixed. The American Kidney Fund, which offers a provider-supported assistance program to cover premiums to qualified patients, was accused along with other third-party payers of aiding and abetting the dialysis companies to shift patients to other plans.

The AKF is also denying claims, published in a Dec. 25 article in the the New York Times, that it shows favor in approving applications for premium assistance to those dialysis providers who have paid into the AKF’s Health Insurance Premium Program––a violation of the federal agreement that set up the program over 20 years ago.

A healthier patient

Whichever plan patients picked, it seemed to help them live longer in 2016. Data through the end of 2013 showed that mortality was receding among prevalent patients, and new starts on dialysis had leveled off. Hospitalizations were also down. Some credit was given to the use of more arteriovenous fistulae.

Legislation and policy

The year 2016 had its share of important events for the kidney community, directed by legislation, policy, and the industry itself. Chief of them is MACRA (the Medicare Access and CHIP Reauthorization Act), which builds a new payment system for physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.

“It’s time to modernize the Medicare physician payment system to be more streamlined and effective at supporting high-quality patient care. To be successful, we must put patients and clinicians at the center of the quality payment program,” said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services.

New legislation included:

  • A bill to expand Medicare Advantage to all individuals with end-stage renal disease. Currently, only those patients already in a Medicare Advantage plan when they are diagnosed with ESRD can be on the plan.
  • Legislation called the Dialysis PATIENTS Act, would allow dialysis providers to form their own integrated networks, similar to the Comprehensive ESRD Care demonstration. Some opposition to the plan has come from providers who believe that a nephrologist should be required as part of managing the network.
  • A bill to approve lifetime immunosuppressive drugs for transplant patients was re-introduced. The legislation has a great deal of support, but concerns about funding the measure, despite recognition that it will help prevent rejected organs because of a patient’s financial hardship, is holding it back.

Certainly, the Center for Medicare & Medicaid Services tinkered with current policies and programs, including a “refresh” on the star rating system. CMS re-opened the application process for the Comprehensive ESRD Care demonstration project, and the agency expects to announce by the end of the month a list of new ESRD Seamless Care Organizations that will be joining the three-year demonstration. https://www.nephrologynews.com/cms-adds-measures-dialysis-facility-compare-updates-star-rating-methodology/