Thursday, November 26, 2009

Medicare Letter--Remember the December 16 Deadline!

200 W. Mercer #104
Seattle, WA 98119

Centers for Medicare and Medicaid Services
Department of Health and Human Services, Attn: CMS-1418-P
PO Box 8010
Baltimore, MD 21244-8010

November 26, 2009

To whom it may concern:

I am a Board-Certified family physician, and I am deeply interested in End Stage Renal Disease for professional and personal reasons. My husband, Steve Williams, was diagnosed with ESRD just over two years ago, and we have been doing Home Hemodialysis since. There is no question that dialysis saved my husband's life, and we have eagerly embraced the technology of Home Dialysis.

I have recently learned about the new Medicare Bundling Plan proposed for activation in 2011. Like any proposal, the plan has its pros and cons. One of the good things about the proposed plan is that is 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 incentivize giving fewer treatments. Currently, the in-Center standard is three treatments per week. Many patients--and one could argue--perhaps all patients could benefit from more frequent treatments. (My husband, for example, receives five treatments per week at home. The more frequent treatments reduce the wide fluid swings he'd otherwise experience--thus reducing his risk of another heart attack.) The new plan would allow for more than three treatments per week if needed.

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 required to learn Home Dialysis. Training for Peritoneal Dialysis requires about one 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 who is associated with ESRD. My wager is that they'd prefer Home Dialysis over in-Center treatments any day of the week.

I trust that issues of adequate coverage for laboratory testing, and the provision of oral medications such as phosphate binders will be worked out. I know your department is getting a great deal of input on these matters.

Thank you for your continued support for the care of End Stage Renal Disease.

Respectfully yours,

Linda Gromko, MD

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