In many ways, kidney disease is the poster child for health disparities in the United States. In 2012, African Americans were nearly four times as likely and Native Americans nearly twice as likely as whites to experience kidney failure (1). African Americans, Hispanics, Native Americans, and Alaska Natives are twice as likely as whites to have diabetes, the leading cause of kidney disease. The incidence of ESRD in people with diabetes is six times as high in Native Americans compared with the incidence in the general population of diabetes patients. Moreover, minority populations spend more time on the
On Tuesday, November 12, 2013, Congress passed legislation that one day could allow individuals with HIV to receive organ transplants from deceased donors with HIV, expanding the total pool of available organs and reducing wait times. Nine days later, President Obama signed the act into law.
ASN made the HIV Organ Policy Equity (HOPE) Act a policy priority, and the society has aggressively pushed for passage of the bill since its introduction in February 2013.
“The HOPE Act could open up the door to hundreds more life-saving organ transplants and reduce the organ transplant waiting list for all 100,000 Americans
In the coming months, the Centers for Medicare & Medicaid Services (CMS) will begin implementing a 2015 law that changes how doctors who provide care to Medicare beneficiaries are paid. ASN is working with CMS to help the Agency get the new system —which aims to reward value over volume—right for nephrology clinicians and the patients with kidney disease they serve.
Last year, Congress repealed and replaced the Sustainable Growth Rate (SGR), the outdated physician payment system that called for substantial annual cuts to physician reimbursement, by passing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
On June 13, 2016, ASN and the Kidney Health Initiative (KHI)—the society’s public-private partnership with the US Food and Drug Administration—participated in a summit the White House convened to address the shortage of organs available for transplantation. The White House Organ Summit brought together a wide variety of stakeholders committed to building on the Obama administration’s efforts to improve outcomes for individuals waiting for organ transplants and support for living organ donors.
Approximately 100,000 Americans are on the waitlist for a kidney transplant alone, and 13 die every day waiting for their name to be called. ASN engaged in dialogue
The US Senate Finance Committee in June launched an ambitious new bipartisan working group that aims to improve the care of Medicare patients with chronic diseases. Concerned that treatment of chronic illnesses—such as kidney disease, heart disease, and diabetes—constitutes 93% of the total Medicare budget, Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR) heard testimony in May from Centers for Medicare & Medicaid Services (CMS) Chief Medical Officer Patrick Conway, MD, and MedPAC Commissioner Mark E. Miller, PhD, about opportunities to reverse this trend, and followed that hearing with the announcement of the “chronic care working group.”
Integration across medical settings and disease phases, led by nephrologists serving as principal care providers, will improve care quality and patient outcomes in advanced kidney disease through renal replacement therapy, end-of-life care, or both.
This statement is the thesis for the kidney care delivery model that the American Society of Nephrology (ASN) is currently developing to submit to the Physician-Focused Technical Payment Advisory Committee (P-TAC), emphasizing that nephrology professionals can improve care, improve patient-centeredness of care, and add value to the healthcare system by spanning care settings and disease phases. In doing so, nephrologists can reinforce a healthcare system in
While the news cycle in recent weeks has been laser-focused on Senate efforts and intra-party debates surrounding repeal and replacement of the Affordable Care Act, bright spots of bipartisan collaboration on other healthcare legislation are quietly proceeding on Capitol Hill.
The Chronic Kidney Disease Improvement in Research and Treatment Act of 2017, introduced in late May 2017, tackles three distinct areas of interest to the kidney community: research, access to treatment, and stability for the Medicare ESRD program. Introduced in the House by Rep. John Lewis (D-GA), Rep. Tom Marino (R-PA), and Rep. Peter Roskam (R-IL), the bill is a
Nearly two years after the Centers for Medicare and Medicaid Innovation (CMMI) announced the first-ever disease-specific innovation model, the first performance period of the ESRD Seamless Care Organizations (ESCO) program is slated to begin in January 2015. Large Dialysis Organization (LDO)-based ESCOs will be the first to participate in the program, followed by ESCOs operated by Small Dialysis Organizations (SDOs) in July 2015. Speaking at a meeting of the Council of Medical Subspecialty Societies in late November 2014, CMMI Seamless Care Models Group Director Hoangmai Phan, MD, confirmed the early 2015 launch date.
Building upon nearly a year of hearings, roundtables, and input from patient and other advocacy groups, the House Energy and Commerce Committee released a draft piece of legislation aimed at spurring the development of innovative new therapies and speeding their delivery to patients. Energy and Commerce Committee Chair Fred Upton (R-MI) and Rep. Diana DeGette (D-CO) launched this bipartisan effort—the 21st Century Cures Initiative—during the last Congress, and the committee floated a preliminary draft bill in January 2015.
ASN has been in conversation with committee staff and the offices heading up components of the draft legislation of potential relevance or
ASN has urged the Centers for Medicare and Medicaid Services (CMS) Survey and Certification Group to delay implementation and foster dialogue regarding a policy concerning saline syringe filling practices. The policy is set to take effect by Sunday, July 2, 2017. Addressed to state survey agency directors, the memorandum states that “ESRD facilities may not fill syringes with saline from the single dose saline bag or IV tubing connected to the patient at the dialysis station” whenever possible. Emphasizing ASN’s commitment to the goal of ensuring patient safety, the society expressed reservations about the memorandum’s recommendations, including concerns about the evidence base for and potential unintended consequences of the new policy, as well as its cost-effectiveness. In a letter from President Eleanor D. Lederer, MD, FASN, ASN encouraged CMS to delay implementation to allow time for public discussion of best practices, including patient and health professional organizations, dialysis providers, and the Centers for Disease Control and Prevention (CDC) – observing that such communication has resulted in implementation of beneficial policies with broad support in the past. “In the absence of any evidence suggesting that pre-filled syringes are an effective strategy to reduce infections, I am concerned that this approach will not necessarily lead to better outcomes despite increasing costs. Before proceeding with nationwide implementation, I believe at the very least CMS should provide an opportunity for all stakeholders, including the CDC, to discuss this new approach. Ideally, a well-powered trial to establish some science on this approach would be funded so that we are implementing evidence-based policy instead of policy that ‘sounds good,’” said ASN Quality Committee Chair Daniel E. Weiner, MD, FASN. As of press time, CMS had not yet responded to ASN’s concerns. Read the society’s complete letter to CMS is online at: https://www.asn-online.org/policy/