Healthy kidneys constantly remove fluid and toxins from the bloodstream. Kidney failure patients on dialysis, on the other hand, usually have their blood filtered no more than three times each week. As a result, dialysis patients almost never feel really good. In my own case, dialysis keeps me alive; my Chinese medicine practitioner keeps me relatively well.
It’s widely accepted that more dialysis is better; that’s why there’s a move to get as many kidney failure patients on daily home hemodialysis as possible. If you’re doing it yourself with a partner as an uncompensated caregiver, the load on the insurance companies and Medicare is lightened (dialysis patients automatically qualify for Medicare coverage).
Last month, Representative Charles Bass (R-Hew Hampshire) introduced HR 5321, the Access to Better Choice in Dialysis Act as a pilot program to demonstrate the impact of daily dialysis treatments.
Under the proposed legislation, a five-year pilot program would be instituted that would reimburse health care providers for up to seven dialysis treatments per week with the purpose of assessing the financial impact of daily dialysis.
The bill calls for the first three treatments per week to be reimbursed at 100% of the standard composite rate with subsequent treatments reimbursed at a decreasing percentage of the composite rate as follows:
- Fourth treatment: 70 percent
- Fifth treatment: 40 percent
- Sixth treatment: 30 percent
- Seventh treatment: 20 percent
Additionally, there would be caps on the Medicare expenditures during the pilot project, as follows:
- First year: US$15 million
- Second year: US$30 million
- Third year: US$50 million
- Fourth year: US$75 million
- Fifth year: US$90 million
The data collected would be used to measure the health status of patients and the changes in expenditures for other health care services—including items that are currently separately-billable including erythropoietin, iron, and hospitalizations—and the working status of patients, specifically reductions in Social Security Disability Insurance payments and increased tax revenues.
If successful and implemented over the long term, significantly more dialysis centers will have to be built, or significantly more hemodialysis patients will have to be moved to a home treatment plan.
The bill is currently in the House Ways and Means Committee and the Committee on Energy and Commerce. House Speaker Dennis Hastert (R-Illinois) has yet to decide how much time the bill will be allotted in the two committees.
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