Senate Finance Committee Eyes Kidney Care Components for New Bill

Patients with kidney disease may see several positive changes to their ESRD care options in 2016. A bipartisan “Chronic Care Working Group” formed by the Senate Finance Committee recently released a white paper outlining policy changes they are interested in enacting this year—including several components related specifically to kidney care.

After soliciting input in June 2015 from ASN and other stakeholders in the medical community regarding opportunities to improve the care of people with chronic conditions and reduce related Medicare expenditures, the committee received more than 1000 suggestions. The white paper narrowed down the feedback to approximately 20 policy options, which are on the short list for inclusion in a piece of legislation to be introduced later this year. Among the suggestions are two provisions for which ASN advocated that are specific to patients with kidney disease and several that would have direct and positive benefits:

Expanding telehealth access for both home hemodialysis and home peritoneal dialysis

Permitting home dialysis patients to interact with their nephrologist for monthly visits via telehealth would create several benefits. Telemedicine may be valuable for ongoing care of patients residing in rural areas, who could avoid the need to travel in dangerous weather or for prohibitively long distances. Permitting patients and their physicians the option to participate in telehealth visits in some months—with in-person visits at least quarterly (every three calendar months)—may incentivize patients to adopt home dialysis as a treatment option.

In its comments to the committee, ASN emphasized that patient safeguards are essential for a patient population that requires ongoing, intensive treatment. Both patients and physicians must retain the option to choose to conduct their monthly clinical assessment visit in-person if that more appropriately meets clinical needs in any given month. The committee’s proposal is currently limited to permitting telehealth interactions that take place at dialysis facilities, but ASN continues to support allowing patients to interact with their nephrologist for some monthly visits from their own home.

Permitting patients with ESRD to enroll in Medicare Advantage plans

Under current law, people who develop kidney failure are not permitted to enroll in Medicare Advantage plans—ESRD is the only pre-existing condition that renders patients ineligible to participate in this program. ASN encouraged the committee to grant ESRD beneficiaries the same freedom of choice and access to improved care coordination services as other Medicare-enrolled individuals and will continue to support the committee’s interest in including it in the final legislation.

Allowing patients with advanced kidney diseases to benefit from new and existing chronic care management (CCM) payment codes

The committee proposed developing a new code that would reimburse physicians who dedicate time to coordinating care for people with multiple high-severity chronic conditions. This concept builds upon a recently created code that reimburses for care of people with multiple chronic conditions (but which are not necessarily high-severity).

More than 50% of patients with chronic kidney disease have 5 or more co-morbid conditions, and CKD is included among 4 of the 5 most costly chronic condition combination triads in the Medicare program. CKD patients could benefit greatly from the proactive, comprehensive care coordination that the newly proposed high-severity codes would offer—providing them superior quality of life, fewer hospitalizations, and better long-term health.

Current CMS policy excludes patients with end-stage renal disease (ESRD) from eligibility for the existing CCM codes during the same 90-day period during which they receive standard—and lifesaving—dialysis care. This exclusion was not legislatively mandated, but rather, implemented during the CMS rulemaking process. ASN strongly believes that patients with kidney disease deserve equitable access to CCM services, and would be among the most likely to benefit from the new high-severity codes.

Among other beneficial policy recommendations the committee may include in its bill are quality measures for chronic conditions and commissioning of a study on medication synchronization. ASN will continue to interact with committee members and staff to build support for these and other policies as they move forward to drafting and introducing a bill. For more details concerning ASN’s recommendations, please visit: http://www.asn-online.org/policy/webdocsAmericanSocietyofNephrologyASN.pdf.