Dialysis patient lobbies D.C. for funding

[okarol]

Dialysis patient lobbies D.C. for funding

By Tiffiny Woo    11/23/2007
Eufaula Tribune

Three days a week, for 3 1/2 hours per day, Eufaulian Nora Jackson lies in a chair at Davita Dialysis Clinic while a machine filters the toxins from her blood that would normally be removed by her kidneys.

Four years ago, Nora had a satisfying career as a middle school teacher in Muscogee County, Ga. until a doctor told her she had lupus.

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Lupus is a disease where the body's immune system begins to attack its own organs-in Nora's case, her kidneys.

Today, she has what is called End Stage Renal Disease, which basically means her kidneys no longer function as they should. She, and 400,000 Americans like her, are left with only three options: transplant, dialysis or death.

That's why Nora has become an ambassador for dialysis patients everywhere. She recently traveled to Washington D.C. to meet with members of Congress in support of legislation that promotes education and awareness in pre-dialysis kidney disease patients. She also lobbied against legislation that would cut government funding for dialysis.

"A lot of people think this is a death sentence," she said, referring to the dialysis treatment. "But many of us are living with dialysis."

Living with dialysis has become a part of her regular routine, she says.

The patients who come to the clinic for treatment have become like a second family to her.

Her need for regular treatments and many dietary restrictions make travel more difficult for Nora.

"You have to arrange to have your treatments wherever you go, which is possible," she said.

Transplants are the best option for ESRD patients, but donor organs are not easy to find for many patients.

"You have to have a match," she said.

"The best match is going to be a family member but people who have risk factors for kidney disease such as diabetes or high blood pressure can't be a donor."

Even for those individuals who are lucky enough to get a transplant, finding a match could take years.

Nora's dialysis costs her approximately $24,000 per month, not including doctor's visits, but unlike many ESRD patients, her insurance and Medicaid coverage pays for nearly all of her treatment.

"I am fortunate that I have good insurance," she said. "Most people are not that fortunate and they can't live without this treatment."

While in Washington, Nora met and spoke with John Perry, legislative assistant to Congressman Terry Everett, and J. Clay Brockman, health policy counsel to Senator Jeff Sessions.

Under question are the Kidney Care Quality and Education Act of 2007 and The Children's Health and Medicare Protection Act.

The KCQEA will promote pre-dialysis education and help with funding increases each year for dialysis patients.
"Currently, each year, someone has to go and lobby for this funding," said Jackson.

The CHAMP Act, she says, proposed to divert funding from pre-dialysis education in order to fund other Medicaid programs.

"The pre-dialysis education can help prevent someone having to be on dialysis," said Jackson. "It teaches people who are at risk to take steps so that they don't develop ESRD."

The Senate will vote on this legislation possibly in December, and Nora urges Eufaulians to get involved by writing, e-mailing or calling their Congressmen.

"Let them know how important this is to dialysis patients."

http://www.zwire.com/site/news.cfm?newsid=19051719&BRD=2235&PAG=461&dept_id=439676&rfi=6

[Zach]

The patient in this article is a perfect example of misplaced advocacy.  She is misinformed on most things she said.

Patients are being used by the "Caring Kidney" lobby without opening their financial books to tell the true story of the ESRD payment system (and its history).

Shame on you "Caring Kidney" folks.  Next thing you'll be doing is asking for patient to donate money to your cause.  Oh, I see you're already doing that, too.
 

[Chris]

Eufaulians ? Not familar with that word, thought it was her first name when I began reading it. nor could I properly pronounce it.

[okarol]

The city is Eufaula, Alabama.

[Hippy]

With the new information about donors may lose health shows this is an important. Many potential good Samaritan donors will
not donate for this reason alone. That seems logical.
   I see no workable alternative for relieving the donor shortage than offering real incentives, just like any other shortage. This can be in many different forms
but what works best is money. Would we be getting many new medications if researchers weren't paid ? If the Pharm company investors didn't get a profitwould they invest ?
   Would we have as many policemen if they only got a thank you and denied health, life insurance ? Or does 40,000 a year help them assume
the risk ? Are paid donors the bad guys ?     "We have seen the enemy, and he is us."
    I can not imagine having the job of asking the mourning family of dead teen age accidents victims for the organs. I would rather vote for politicians making it legal
for donors to sell their kidney. 
   I think we are kidding ourselves to look elsewhere. 

[Aldente]

The patient in this article is a perfect example of misplaced advocacy.  She is misinformed on most things she said.

Zach, I'm curious as to which items she mentioned that you feel she is misinformed about?

[Rerun]

As long as DaVita makes billions and the CEO makes Millions I'm not asking Congress for a dime.  I feel like telling Congress the truth! 

I agree with Zach!  Shame on Kidney Care to ask the tax payers for more when we don't need more money.  We just need to stop watching the stock market and take care of the customers.  Do people realize the dialysis centers hold us as hostages to get more money.  Using SICK people to get more money from tax payers.

I'm all for making a profit, but not at the expense of tax payers and the ill.

[Zach]

Read the following NY Times article on how the Oxygen Suppliers are using their patients to lobby congress to keep Medicare reimbursing at higher rates -- as much as $8,280, -- or more than double what somebody might spend at a drugstore.

http://www.nytimes.com/2007/11/30/business/30golden.html?hp

Unless these "Caring Kidney" folks open their books so we can see where the money goes, people on dialysis should not do their bidding.
 

[Bill Peckham]

The patient in this article is a perfect example of misplaced advocacy.  She is misinformed on most things she said.

Zach, I'm curious as to which items she mentioned that you feel she is misinformed about?

Since Zach wont answer I'll point out one: She said her Medicare and Medicaid paid about $24,000 a month - there is no way that is true. It could be $2,400. I assume Eufaula, Alabama is at the low end of the reimbursement wage adjustment so 100% of the Medicare rate would be about $135 per treatment, add in medications, labs, etc. and you could get to $2,400/month. If Medicaid in Alabama doesn't pay all of the 20% not covered by Medicare (which they may not) then Nora could even be an average user of epo and other medications which typically makes up about 30 - 40% of unit revenue for someone who is Medicare primary. (source USRDS Precis)

Zach I think your have not made your case that dialyzors are being used; you have not made the case that it is against a dialyzor's self interest to lobby to stop the annual inflation cut built into dialysis reimbursement. I support HR1291/S635. The bill's improvements are wholly justified on their own terms. The HR1291/S635 improvements are: pre-dialysis modality education, stage 4 Chronic Kidney Disease (CKD) outreach, national technician certification and a fix to the only Medicare program with reimbursement rates that do not change with inflation - the only Medicare program that does not fund annual cost of service updates to their reimbursement rates - that would the best use of the MSP savings.

This is what Nora is talking about - Congress is being presented with a binary choice - we (Congress) will extend MSP and bundle the composite rate; we will use the projected savings to either fund children's healthcare or these improvements to the dialysis program. If that money leaves the dialysis program to fund childrens insurance it's not coming back. I think Nora knew exactly what was at stake and should be applauded for her effort.

In 1972, Congress launched an experiment - the US government would not let people with stage 5 CKD die for lack of treatment - Congress made a promise. Congress promised that this chronic disease would be supported through Medicare; the federal government would pick up 80% of the cost of treating this disease. After 35 years of cost shifting and inflation eroded reimbursement the US dialysis program lags far behind the care experienced by people on dialysis in other industrialized countries. We are not meeting the care our neighbors expect to be delivered. We are not keeping the promise.

The US dialysis program lacks a vision of a sustainable, humane, thoughtful program. A program that is  an all cost efficient system of support for people on dialysis. A program that would achieve all cost efficiency through achieving world class clinical outcomes. It is possible to design such a system but not within the current program structure.

Resist the temptation to bring in CEO salary which is a pointless distraction. Unless the you're a Davita stockholder it is a moot point, and if you are a Davita stockholder you probably reckon Thiry earned his stock options.

[Bill Peckham]

Read the following NY Times article on how the Oxygen Suppliers are using their patients to lobby congress to keep Medicare reimbursing at higher rates -- as much as $8,280, -- or more than double what somebody might spend at a drugstore.

http://www.nytimes.com/2007/11/30/business/30golden.html?hp

Unless these "Caring Kidney" folks open their books so we can see where the money goes, people on dialysis should not do their bidding.
 

According to the article "Medicare spends billions of dollars each year on products and services that are available at far lower prices." hmmm Where can one get dialysis for less than Medicare rates? South Africa? They charged $175 but I think they changed locals less. Zach was it South Africa you were thinking about? Where dialysis is "available at far lower prices."

[Zach]

According to the article "Medicare spends billions of dollars each year on products and services that are available at far lower prices." hmmm Where can one get dialysis for less than Medicare rates? South Africa? They charged $175 but I think they changed locals less. Zach was it South Africa you were thinking about? Where dialysis is "available at far lower prices."

Once again, Bill, you miss the point.
 

[Bill Peckham]

Once again? Hello kettle? This is Zach. You're black.

Here is an article that one does not need to register to read http://www.bmj.com/cgi/content/full/335/7630/1126 and it actually provides sources and citations. Here is a quote you'll like "US firms have found that raising revenues by exploiting loopholes or lobbying politicians is more profitable than improving efficiency or quality." So the article makes your point but it does not embrace your solution.

Summary points of the article are

• The US has long combined public funding with private healthcare management and delivery
• Extensive research shows that its for-profit health institutions provide inferior care at inflated prices
• US experience shows that market mechanisms undermine medical institutions unable or unwilling to tailor care to profitability
• Commercialisation drives up costs by diverting money to profits and fuelling growth in management and financial bureaucracy
• The poor performance of US health care is directly attributable to reliance on market mechanisms and for-profit firms and should warn other nations from this path

Rather than allowing private reimbursement to wither which would not be in the interest of people who rely on medical care the authors suggest the solution is

• adequate dosing of public funds
• budgeting on a community-wide scale to align investment with health priorities and stimulate cooperation among public health, primary, and hospital care; encouragement of local innovation
• explicit empowerment of patients and their families
• intensive audit for improvement, not reward or blame
• a system based on trust and common purpose
• leadership not by corporations but by "imaginative, inspired, capable and . . . joyous people, invited to use their minds and their wills to cooperate in reinventing the system, itself . . . because of the meaning it adds to the lives and the peace it offers in their souls.

A rather longterm solution. I imagine to some the hard work of changing the structure of US healthcare is less appealing than blaming equity profits.

[Zach]

Once again? Hello kettle? This is Zach. You're black.

A rather longterm solution. I imagine to some the hard work of changing the structure of US healthcare is less appealing than blaming equity profits.

No Bill, you still don't understand where I'm coming from.

I wish I had the ability of a Paul Krugman, to write a coherent op-ed.  He's great at explaining the realities of current issues.  But alas, I am no Paul Krugman.

I've written bits and pieces throughout IHD on the subject, and I just need to move on.
But yes, I will still heckle on occasion.
 

[Rerun]

Let's finish this Bill.  DaVita makes a HUGE profit.  Why oh why does Medicare need to pay more?  If we as patients (dialyzors) aren't getting the right care now.... no amount of money from Medicare will make a difference.  It will go right into the CEO's pockets.

[kruep]

Rerun, you are so right.  When a clinic shows a larger profit that money does not stay in that clinic.  They ask you how you can do more with less.  It is like a vicious cycle.  The more you do with less the more they expect.  I'm not saying that I am afraid of hard work but it gets old when someone is standing behind you counting bandaids and wondering why you are having to work extra to get charting done when you are the only RN for 20 patients a shift and running 3 shifts a day.  I will do anything in my power for my patients but it gets disheartening when you see how much money the upper management makes and then you see how hard some of the techs are working and they have to decide whether to buy that tire for their car so they can make it to work or pay their electric bill.
Fed up with DaVita,
kruep

[Bill Peckham]

Let's finish this Bill.  DaVita makes a HUGE profit.  Why oh why does Medicare need to pay more?  If we as patients (dialyzors) aren't getting the right care now.... no amount of money from Medicare will make a difference.  It will go right into the CEO's pockets.

Davita is not the entire dialysis industry but they are the highest profile company so I'll try to answer your question keeping your focus in mind. So "why does Medicare need to pay more?" (even to Davita).

• Those profits are not from Medicare payments per se, they're achieved by economies of scale and charges to private insurers.
• If you aren't getting the right care now then the fix would be to change the conditions for coverage or your state's survey procedures.
• CEO and upper management pay at Davita is typical in the US economy, for company of their size.
• Adjusting reimbursement to account for inflation is not increasing reimbursement

Those profits are not from Medicare payments per se, they're achieved by economies of scale and charges to private insurers.
According to wikipedia economies of scale characterizes a production process in which an increase in the scale of the firm causes a decrease in the long run average cost of each unit. Davita and FMC are large dialysis organizations (LDOs); both enjoy economies of scale with over 100,000 patients consuming over a million treatments a year (units). If Medicare were to reimburse based on the cost structure of the LDOs then that would make the smaller providers unable to sustain operations unless they make cuts to expenses. There is a trade off here, lower Medicare reimbursement increases industry consolidation or diminishes quality of care.

Zach would like to see Davita's books but there is already a lot of information available, information that matches my understanding of dialysis economics. From Hospital-based dialysis centers perspectives from the for-profit sector in Healthcare Financial Management,  June, 2005  by Peter W. Ketchum

A review of data concerning Renal Care Group and DaVita shows that these companies have average payment rates, including ancillaries, of about $315 per treatment, which implies commercial payment rates in the neighborhood of $700 per treatment. Because the net payment rates from commercial payers are usually subject to contractual allowances, the implied charge per treatment is higher. Anecdotal evidence suggests that a charge of $600 per treatment, excluding ancillaries, is not unusual.

And according to Davita's 8-k financial filling for the 3Q 2007 http://tinyurl.com/24w9mg:

• Davita operated or provided administrative services at 1,344 outpatient dialysis centers serving approximately 106,500 patients
• Davita projected operating income for 2007 in a range of $800-810 million

So if Davita has about 10% private pay patients (10,000), each on average contributing $500 per treatment in profit (if you assume Medicare is about break even, which it is according to MedPAC) than for the year those private pay patients are generating over $700,000,000 of Davita's operating income depending on the average number of treatments per year. With a slight increase in per treatment revenue from the private payors or an increase in number of treatments per year from 140 to closer to 156 nearly all of Davita's operating income can be traced to private pay patients. Any income derived from Medicare primary patients can be traced to Davita's economy of scale.

If you aren't getting the right care now then the fix would be to change the condition for coverage or your state's survey procedures.
Reimbursement could be used to reward better clinical outcomes; the Bill (HR1291/S635) would start us down that road but if you favor leaving reimbursement unchanged than you take that off the table. Getting people the "right care" is the job of Medicare rules as enforced by state surveyors. Medicare rules are primarily the conditions for coverage (CfC) which are in the process of being revised. Here is a summary of changes contained in the three hundred pages of proposed CfC (PDF): http://www.heartlandkidney.org/news/2005_news/Proposed%20Conditions%20of%20Coverage%20Synopsis.pdf the actual proposed CfCs are here: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/05-1622.htm. This is where the obligations of a dialysis provider are spelled out.

If a unit is not meeting the CfCs then it is the state's responsibility to identify shortcoming and force corrections. How states do this vary among the 50 states, some states are better than others but it is not a function of reimbursement. I'll be in MD at a CMS meeting that will develop the survey guidelines to go with the new CfCs but what happens if a unit is out of compliance is not clear but this is another issue.

CEO and upper management pay at Davita is typical in the US economy, for company of their size.
Davita is huge company with over 5 billion dollars in revenue - huge salaries come with huge companies. What do you suggest? Companies that are 1% Davita's size pay their people more than 1% of the pay received by Davita executives, therefor if you were to break up Davita into 100 companies total executive pay at those 100 companies would be more than total executive pay at Davita.

Adjusting reimbursement to account for inflation is not increasing reimbursement
Does this have to be explained?

[Rerun]

"CEO and upper management pay at Davita is typical in the US economy, for company of their size."  Quote from Bill Peckham

Bill, that makes me cringe to compare DaVita who is in business to take care of people with chronic kidney disease to the Frotune 500.  It is not right to get filthy rich from sick people that the country has decided to keep alive with their tax dollars.  I'm private pay until March.  At some point everyone ends up on Medicare wheather they have private insurance or not. 

I'll just reach into my insurance file and grab an Explanation of Benefits.  Okay I have July 2007 Davita.  Submitted Charges, $27,445.50. Plan Allowance $4,661.44  That is what they paid and I owe $269.43 which I assume Medicare picks up.  Why the hell don't they submit $100,000 because they only get $4661.44 and they KNOW that.   

Now, that doesn't even include the labs which are another $200 and the doctor which is another $500.  Oh, Hell, and if something goes wrong like a fistula clot the hospital is another $46,000 and the surgeon another $11,000!!!  You all know this.  I'm just preaching to the choir!

If they make that much money they shouldn't be running short handed and counting bandaids. 

What is the difference between DaVita getting rich off tax dollars and Farmers getting rich off tax dollars.  I'll tell you the difference.  The Farmers benefit ALL of us and keep our food cheap and safe.  Our Farmers may make a small profit but the government has payment limitations on them.  They may qualify for $2 million but they have a hundred thousand dollar payment limit.
DaVita only benefits a small few and most of them shouldn't be on dialysis anyway!  Jesus!  When you have to drag them in on a stretcher and hoist them into the chair.....You need to let go PEOPLE!

Profit index....economics of scale... call it what you like.  Enron called it "Futuristic Accounting" when they were ripping off the people of California.


I won't support this kidney care bill.     

[Bill Peckham]

Letting Medicare reimbursement erode via inflation feeds the LDOs. There is a trade off here, lower Medicare reimbursement increases industry consolidation and/or diminishes quality of care.

There is going to be something put forward on Wednesday by the Senate Finance Committee, it's said that they will propose to both bundle medications with treatment reimbursement and extend the private the private payer period to 42 months, both of these proposals will tend to favor LDOs unless there is specific language included. Things are always in the specifics. If it were up to me we'd leave things as they are until after the elections in 2008.

Rerun do you know which company owns your hospital? How much did their CEO make last year? When Columbia/HCA's chief executive officer resigned in the face of fraud investigations into the company, he left with $324m in company stock. Tenet's chief executive exercised stock options worth $111m shortly before resigning under pressure from investors in 2003. The head of HealthSouth (the dominant provider of rehabilitation care, mostly paid for by Medicare) made $112m in 2002, the year before his indictment for fraud (charges of which he was later acquitted) and four years before his conviction on unrelated bribery charges. http://www.bmj.com/cgi/content/full/335/7630/1126#REF30 

[Zach]

The head of HealthSouth (the dominant provider of rehabilitation care, mostly paid for by Medicare) made $112m in 2002, the year before his indictment for fraud (charges of which he was later acquitted) and four years before his conviction on unrelated bribery charges. http://www.bmj.com/cgi/content/full/335/7630/1126#REF30 

And now coverage by Medicare is limited for outpatient Physical Therapy (PT) except when the PT is performed in a hospital outpatient department.

Seems HealthSouth did not pay enough for its lobbyists.  This is my point and the point of the article.

Reimbursement for medications used by the larger dialysis organizations (LDOs) was reduced in one proposed bill in Congress, since these LDOs have economy of scale.  Smaller dialysis centers would continue to receive current reimbursement based on average sales price + 6%, while the larger dialysis organizations (LDOs) would receive reimbursement based on average sales price + 2% -- reduced but still a good profit.

The "Caring Kidney" lobby screamed bloody murder and had patients write-in to stop the so-called 4% "cut" in Dialysis Reimbursement.

Economies of scale dictate that the larger centers such as DaVita should be reimbursed at a slightly lower rate than the smaller, struggling dialysis centers.  That's how you help prevent consolidation.  It's fair and equitable.

But as we've already seen, the "Caring Kidney" lobby won't allow that.

Now I'm going to keep my mouth shut and let others speak up.
 

[Bill Peckham]

Reimbursement for medications used by the larger dialysis organizations (LDOs) was reduced in one proposed bill in Congress, since these LDOs have economy of scale.  Smaller dialysis centers would continue to receive current reimbursement based on average sales price + 6%, while the larger dialysis organizations (LDOs) would receive reimbursement based on average sales price + 2% -- reduced but still a good profit.

The "Caring Kidney" lobby screamed bloody murder and had patients write-in to stop the so-called 4% "cut" in Dialysis Reimbursement.

Economies of scale dictate that the larger centers such as DaVita should be reimbursed at a slightly lower rate than the smaller, struggling dialysis centers.  That's how you help prevent consolidation.  It's fair and equitable.

But as we've already seen, the "Caring Kidney" lobby won't allow that.

Now I'm going to keep my mouth shut and let others speak up.
 

You're conflating two elements of the CHAMP act.

• Sec. 635. Adjustment for erythropoietin stimulating agents (ESAs) for large dialysis organizations (LDOs) (defined as 300 facilities or more as of July 24, 2007).  For 2008 and 2009, adjusts payments for Epogen for to the lower of $8.75 per 1,000 units or 102 percent of ASP, and payment for Aranesp to the lower of $2.92/mcg or 102 percent of ASP.
  
  
• Sec. 637. Development of ESRD bundling system and quality incentive payments. Beginning January 1, 2010, would create a bundled payment for dialysis and related drugs and services, with certain requirements to ensure appropriate anemia management. In so doing, total payments would be limited to 96 percent of total estimated  payments for all ESRD services if there were no bundled payment system.  Bundle includes ESAs, laboratory and diagnostic services, and home dialysis training.  Case mix adjusters include weight, BMI, co-morbidities, length of time on dialysis, age, race, ethnicity, and other factors. (These may be from the CMS bundling report which has not been released.)  Allows for a payment adjustment for high cost outliers, including high utilizers of ESAs, and other payment adjustments such as for geography, pediatrics, small/low volume and rural providers. Allows for a four year phase-in for certain providers, but requires full implemented by the end of 2012.
  
  Would also provide quality incentive payments for dialysis providers for July 1, 2008 through December 31, 2010 and again in 2011, including anemia management between 33 and 39 percent hematocrit, iron management, dialysis adequacy, vascular access, and patient satisfaction.  The payment base for the quality incentive payment for performance periods before 2010 (the bundle) includes the drug add-on adjustment. Quality incentive payments are set at 1.0 and limited to $50 million in 2008, 2.0 percent and limited $100 million in 2009, and 2.0 percent and limited to $150 million in 2010.  Payment would be a single consolidated payment.

When you read the two sections in concert (which is how one should read legislation) you can see that the LDOs are paid less until bundling goes into effect in 2010. Then in 2010 the CHAMP act would have cut 4% from payments for all ESRD services. I still do not understand why you would favor removing 4% from the federal ESRD program. If the CHAMP act had passed not only would there have been a 4% program cut in 2010 there would continue to be the yearly inflation cut. Had this passed it would have increased industry consolidation and/or diminished quality of care.

I think Nora understands the legislation and the legislative process better than you do.

[Zach]

If it were up to me we'd leave things as they are until after the elections in 2008.
 

That is probably the best way to go right now.  So people should write their Washington Reps and Senators not to take action on current legislation.

What we also need is independent research from say, the RAND Corporation, to analyze for us patients the various ESRD bills before Congress--what are the true costs, what are the pros and cons, benefits and risks.

Maybe the Renal Support Network (RSN) would be willing to pay for such an independent study.  As it stands right now, most of the "facts" come from the "Caring Kidney" lobby--not a disinterested party.
 

[Bill Peckham]

Here is some independent information from the census bureau. My Take away 8-10% of the dialyzors (those with private health plans) provide over a third of the revenue and through that you can see private payers provide pretty much the entire margin.

(PDF link see page 21) http://www.census.gov/svsd/www/services/sas/sas_data/62/2006_NAICS62.pdf


KIDNEY DIALYSIS CENTERS (NAICS 621492)
.Patient Care Revenue
..Medicare ………………………………………...……………………………………$ 7,044
..Medicaid ………………………………………...…………………………………………667
..Other government (Veterans, NIH, Indian Affairs, etc.) …………………………………  146
..Worker’s compensation ………………………………………...……………………………………  ZZ
....Private health insurance ………………………………………...………………  4,477
…Property/Casualty and auto insurance ………………………………………...……………        S
..Patient (out-of-pocket) ………………………………………...………………………………………  94
..All other patient care sources not elsewhere classified ……………………………………  491
.Non-Patient Care Revenue
..All other sources ………………………………………...………………………………………………… 26

(all numbers in millions of dollars)

[Zach]

Here is some independent information from the census bureau.

Sorry Bill, but you still don't get it.

I'm talking about the proposed laws by the "Caring Kidney" lobby.  These bills sound nice and have been, at times, reduced to very simplistic promotion efforts, i.e. H.E.A.R.T.

It is important to note that the Renal Support Network has links to the complete language of H.R. 1193 and S. 691., while the "Caring Kidney" folks do not (at least not easily found on their site).

My point is that patients need an independent analysis of these bills--their costs, their pros and cons, where are the weaknesses and strengths.

That's why I wrote that the Renal Support Network (RSN) should be willing to pay for an independent study by an organization such as the RAND Corporation.
 

[Bill Peckham]

You need the RSN to tell you why an inflation adjustment is fair? RSN is part of the Kidney Care Partners coalition (as is the Northwest Kidney Centers ((as of December 2007))) so I'm not sure you would be getting the different perspective that you're looking for; I think you're stuck slogging through the information that is available along with the rest of us. It would be nice to have perfect knowledge but instead you'll have to make do with what you got.

The changes being contemplated right now are not even available for us to evaluate. Who knows what will be proposed and signed into law - at this point based on the rummors of what is being discussed those changes would be best left undone. It's not that good changes couldn't be made it's that they are not being discussed.

In general I think the number one thing that could be done by the federal government is to account for the total cost of an ESRD Medicare beneficiary and then provide care that reduces the total cost. Part A, Part B, Part D, tax receipts and disability costs - minimize the total economic costs rather than to try to decrease spending in each category independent of spending elsewhere in government (at all levels of government). The only reason bundling is on the agenda and more frequent dialysis is no where to be seen is because of the artificial wall between Part A and Part B spending. If the artifical accounting wall could be torn down (Mr President. Tear. Down. This. Wall.) the entire discussion would change. Still you'd continue to be left to form your own opinions on whether to support the changes.

[Zach]

You need the RSN to tell you why an inflation adjustment is fair?

Bill, you still don't get it.

People on dialysis need an independent analysis (of the inflation adjustment, bundling, etc.), as I have said, by an organization such as the RAND Corporation.  And it should be paid for by RSN, because independent information is in the best interest of people on dialysis.