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Improving Care for Patients
with Kidney Disease
The House of Representatives passed a historic rewrite of the Medicare ESRD program. This is the first major restructuring of the program, and thus it is critical that we get it right. The Children’s Health and Medicare Protection Act of 2007 (CHAMP Act) would create important new programs to raise awareness about the causes of kidney failure and to educate patients about their disease and the treatments available to them.
However, the CHAMP Act includes reforms that cut reimbursement from an historically under-funded program. In fact, MedPAC has documented that Medicare composite rate payments are insufficient to meet the costs of a dialysis patient’s care. As is common in Medicare, the ESRD payment structure has relied on a cross-subsidization between drug payments and an economically unviable composite (care and service) component. However, while MedPAC recommends adjusting the composite rate for inflation each year, the composite rate has only been updated six times in its 25-year history.
We urge the Conference Committee to fully fund the service component. Reform must not compromise the quality of care or endanger patients by removing resources from an already overstretched system.
Kidney Care Partners urges Congress to enact legislation that:
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Ensures continued quality by implementing an annual update mechanism. The ESRD program is the only sector of Medicare that does not have an annual update mechanism to adjust payments for inflation. Each year, MedPAC recommends that Congress enact legislation to increase the composite rate for dialysis services but in many years, Congress fails to act. Congress needs to enact a self-implementing system similar to those of all other Medicare providers. -
Applies savings generated by payment reform to program improvements. Savings generated by implementing payment reforms should be directed to needed improvements in the ESRD program, such as uncapped quality payments. -
Carefully designs parameters for payment reform. Congress should provide sufficient guidance for a bundled payment system, but the Agency needs to retain implementation flexibility. In addition, we believe there are benefits to be achieved by testing payment reforms prior to implementation.
As Congress considers revisions to the ESRD program as part of a broader Medicare reform package, we must not lose sight of what is most important: patient safety and well-being. The principles of reform stated above are critical to provide for financial stability, promote high quality care, and ensure patient safety. | 
