Updates on Public Policy for Nephrology 2024: From the Hill and Medicare to Nephrology Practice

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Much like any other year, the first quarter of 2024 has experienced a kaleidoscope of public policy issues impacting nephrology (Table 1). Beginning with legislative priorities, in early March, Congress passed fiscal year (FY) 2024 appropriations legislation that included a partial payment fix in the Medicare conversion factor (CF), providing an additional 1.68% offset in the CF for the balance of 2024. (The CF was originally scheduled for a 3.37% cut.) Also included was an extension of the bonus for participating in Medicare alternative payment models (APMs) for 2024, albeit at a reduced rate of 1.88%. (For 2023, it was 3.5%.) These issues were legislative priorities for the Renal Physicians Association (RPA) for 2024, and these changes represent victories for nephrology and organized medicine broadly. However, the work is not complete, as medicine has still sustained an approximate 2% cut relative to 2023.

Table 1

Public policy updates impacting nephrology practice

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Congress is also deliberating on numerous bills pertaining to organ donation, including the Living Donor Protection Act of 2023 (HR 2923/S 1384) (1, 2), which has great co-sponsor numbers but has been bogged down procedurally. Other significant kidney-specific legislative initiatives this year include an effort to reverse the Supreme Court decision from 2022 and restore Medicare Secondary Payer (MSP) protections for patients with kidney failure (3) as well as the advancement of legislation to delay inclusion of oral-only drugs in the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) bundle (4). Note that this year's high level of Congressional dysfunction hampers clear expectations for all legislation.

On the regulatory side, a new complexity add-on code, G2211, has been implemented in the Medicare Physician Fee Schedule. This code can be added to most outpatient evaluation and management (E&M) services for complex patients with whom the nephrologist has an ongoing, longitudinal relationship and thus should be compliantly billable with most E&M services provided to patients with chronic kidney disease covered by Medicare. The RPA has issued guidance for the use of this code in nephrology practice (5). Another recent development with a potential impact on nephrology is the 2025 Medicare Advantage Advance Notice, which has rate-setting implications for Kidney Care Choices (KCC) voluntary kidney models. There was negative news for kidney care in last year's Advance Notice (for 2024), in which the rate setting resulted in an approximate 8% decrease overall in the kidney model payment rates. A repeat of this level of reduction is not expected for the next performance year but is projected to be approximately 3%–4%, which would result in a cumulative 2-year reduction of 11%–12%. Finally, the RPA will soon be leading an effort to revise a family of dialysis access codes as part of the Current Procedural Terminology (CPT) Editorial Panel process, after which the American Medical Association's Relative Value Scale Update Committee (RUC) would value the codes. The RPA has represented the nephrology specialty with both the CPT and RUC for the last 30 years.

As has been the case throughout its 50-year history, the RPA will continue to monitor these socioeconomic concerns on behalf of all nephrologists and seek to collaborate with kidney community leaders, such as ASN and others, as it strives for optimal kidney care for all.