Members of the U.S. House of Representatives are signing a letter to be sent to the Centers for Medicare & Medicaid Services saying the agency went too deep on its proposed 9.4% payment cut to dialysis providers.

Members of both the House and the Senate sent letters to CMS in May advising it to make sure the planned cut to the ESRD bundle, mandated by Congress as part of fiscal cliff legislation in December, not hurt dialysis patient care. CMS was mandated to make a cut to the composite rate after two investigative reports released earlier this year from the Office of Inspector General and the Government Accountability Office concluded that the agency was paying for erythropoiesis-stimulating agents based on usage by dialysis patients in 2007. ESA use has dropped more than 20% since then, but CMS did not adjust the composite rate payment. The proposed 9.4% cut, which would take $780 million out of the ESRD program, is to compensate for the lower use of ESAs.

 But some Congressional members say it is too much. “The proposed cut in payments in the pending rule constitute a 12% or a $30 reduction of what would otherwise be $246 prospective payment for dialysis,” the letter, obtained by Inside Health Policy, said. “A cut of this magnitude to an industry that, according to the Medicare Payment Advisory Commission, has just 3-4% Medicare margins, could result in closure of dialysis facilities and a reversal of many recent gains that have been made in improving quality of care and mortality for dialysis patients.

 “This cut, if implemented in the final rule, would threaten the very viability of the ESRD program,” the lawmakers wrote. “CMS ha a statutory obligation to assure that payments for dialysis cover costs.”

Early signers to the letter, released July 22, include Reps. John Lewis, D-Ga., Diane Black, R-Tenn., John Shimkus, R-Ill., and Ben Ray Lujan, D-New Mexico.