Saturday, November 7, 2009

Who Would Guess? Medicare Bundling Meeting was Interesting and Important

Any meeting dealing with Medicare payment methods would ordinarily be a root-canal equivalent for me: if not painful, at least as boring as watching paint dry!

But today, I attended the Northwest Kidney Centers' meeting on the new Medicare Bundling Plan proposed for activation in 2011. This payment system will impact the way dialysis services will be paid for by Medicare.  I learned at the meeting that, by law, all public input must be recorded and responded to; so our input can matter. The deadline for public input on the new system is December 16, 2009.

Bundling is not a new concept in health care reimbursement. But as new rules are established, it's important to ensure that costs are properly covered, cost savings are observed -- and, most importantly, that quality of patient care does not suffer! There are many components to the new plan, but I'll touch on only a couple of points today.

One of the good things about the proposed plan is that it continues to reimburse for dialysis services on a per treatment basis. This is important because to reimburse for dialysis treatments on a per month or per patient basis could disincentivize treatments. In other words, a Dialysis Center could theoretically profit by giving fewer total treatments! Currently, the in-Center standard is three tratments per week. Many patients -- and one could argue -- perhaps all patients benefit from more frequent treatments. (For example, my husband Steve gets five treatments per week at home. The more-frequent treatments reduce the wide fluid swings he'd otherwise experience -- thus reducing the workload on his heart and minimizing his risk of having a heart attack.) The new plan will allow for more than three treatments per week if justified.

One problem I see with the new proposal, however, is that it does not provide extra funding for the labor-intensive one-on-one training for Home Dialysis. Home training for Peritoneal Dialysis requires about a week. Home Hemodialysis training is longer, i.e. four to six weeks. And while the training is expensive, the cost ultimately equalizes out, with Home Dialysis costing slightly less to administer than in-Center treatments. The real point, though, is this: Home Dialysis improves quality of life! There's less depression, fewer admissions to the hospital, and less exposure to infection. The new Medicare provisions do not account for these savings. But ask any physician, nephrologist, or anyone else who is associated with "KidneyWorld." My wager is that they'd prefer Home Dialysis over in-Center treatments any day of the week.

Another very insightful concern brought up by one of the dialysis patients at the meeting was that the new proposal didn't allow for funding for innovations in therapy. The gentleman brought up the concept of the "wearable" artificial kidney. He also brought up the pioneering concept of  "growing" organs for transplant. Such ideas aren't considered in the new Medicare modifications; we hope the plan will feature some flexibility as these miracles materialize.

I'll be writing my letter to Medicare soon, and I'll share it on this blog. But, heads up! We do need to concern ourselves with this matter. Our opinions apparently do count. Who better to weigh in than the folks who are directly impacted?

For more info, go to the blog of my hero, Bill Peckham (nineteen years on dialysis): Comments to Medicare may be submitted online through the website of the Northwest Kidney Centers at

Take care. Linda Gromko, MD

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