As lawmakers consider different ways to repeal and replace the Affordable Care Act, one thing remains certain: when the dust settles, millions of Americans will be watching, waiting, and expecting policies that improve their health, access to healthcare, and how they receive it.
More than half a million of these Americans are living with End Stage Renal Disease (ESRD) – also known as kidney failure – and have a tremendous stake in the sustainability and effectiveness of our healthcare delivery system. So too do the approximately 17 percent of Americans living with the earliest form of the condition, Chronic Kidney Disease (CKD). These Americans living with ESRD and CKD require complex and multifaceted care plans involving multiple medications, physicians and care settings to manage their conditions with therapies like dialysis and kidney transplantation. Preserving and protecting their ability to access high quality healthcare is critical, and should be without burdensome obstacles.
Time is of the essence. While the kidney community has worked constructively with policymakers and key stakeholders to demonstrate sustained quality improvement in key areas, the Medicare coverage upon which most Americans with kidney failure rely upon is at a critical crossroads. Congress and the administration must ensure the integrity of these coverage options now and into the future, lest we see a reversal or a slowing of this positive trend.
This year, the kidney community is working with lawmakers to assure stability of the ESRD program by protecting access to commercial insurance options. During the last few years, health plan issuers have been able to discriminate against patients in need of dialysis, despite the federal requirements stipulating that they cannot take pre-exiting conditions into account when making coverage decisions. For example, some insurers have prohibited patients from using charitable assistance to help pay premiums – making those plans too costly for patients who rely on those payments to retain their coverage. Others have essentially forced dialysis patients to enroll in Medicare, ignoring their right to remain on a commercial insurance plan if they desire the additional coverage. These discriminatory practices must be stopped. Patients must be afforded options to enroll in the insurance plan of their choice so they can access critical therapies like kidney transplantation, home dialysis, and in-center dialysis therapy.
We must also create a stronger ESRD program by fixing problems with Medicare’s payment and quality monitoring programs.
Although the kidney community embraced the bundled payment model when Congress debated it in 2008 - and worked closely with CMS to ensure it was implemented appropriately in 2011 - the current ESRD Prospective Payment System (PPS) has several methodological flaws that result in the loss of federal dollars originally allocated for patient care. On top of that, Medicare currently implements several inconsistent, confusing, and burdensome quality programs – draining both money and manpower from an already strained system.
Further, the future of successful care for our patient population is dependent on our ability to innovate. It’s a fundamental belief of Kidney Care Partners. In fact, the renal community was the first group of healthcare providers to embrace the ESRD Quality Improvement Program (QIP), a payment system based on the value of care provided rather than the volume. Assuring a stable, sustainable ESRD program through innovative patient care models is something we continue to work toward with our government partners.
History has shown that, by working together, it is possible to achieve meaningful change. In fact, just last year, the kidney community supported the bipartisan 21st Century Cures Act, which finally allowed Medicare beneficiaries with kidney failure access to Medicare Advantage (MA) plans. Previously, Medicare patients with ESRD were prohibited from enrolling in MA plans – a choice afforded to all other Medicare beneficiaries. Thanks to the 21st Century Cures Act, this discriminatory practice was eliminated.
With the goal of better care and healthier lives for the millions of Americans with kidney disease through a stronger Medicare program, Kidney Care Partners will continue to work closely with members of Congress and the new administration to develop smart and effective policies for patients in need of kidney care.
Kidney Care Partners (KCP) is the nation’s leading coalition of patient advocates, kidney disease professionals, dialysis care providers, researchers and manufacturers dedicated to working together to improve quality of care for individuals with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD). For more information: http://kidneycarepartners.com
The views expressed by this author are their own and are not the views of The Hill.