When linking to my S 3101 post yesterday RenalWEB included an editorial comment:
In trying to fix the problem of the overuse of drugs in ESRD care, the legislators appear to be exacerbating the problem that is becoming accepted as the the biggest mistake in ESRD care for the last 35 years - the inadequacy of short, fast, three-times-a-week hemodialysis treatments for optimal health. Such legislation should return to its original intention in 1973 - empowering those ESRD patients, who so wish, to lead productive, fulfilling lives.
Indeed.
There have been reports that show overuse of ESAs by some dialysis providers, but if the ESRD provisions in Baucus's bill are meant to correct that situation (a situation that may have already been corrected with the November 2006 revision to the dosing guidelines) it is a misguided effort. There is a disconnect between the Senator's stated position in support of nonprofit community based healthcare and the language of this bill that differentiates payments based on unit size rather than provider size.
If you want to support and encourage nonprofit community based healthcare then you have to support legislation that acknowledges their purchasing disadvantage compared to large corporations. If dialysis reimbursement is set based on the purchasing power of the two large dialysis organizations it will disadvantage providers with less purchasing power i.e. everyone else, the small dialysis organization (SDO). It is within Congress's power to pay a differential - pay different rates to different types of providers - they have done it for years for hospital based providers. In fact this new legislation is said to do away with that differential, (it's interesting that today there is about the same percentage of people dialyzing through SDOs as there were dialyzing through hospitals back in 1983 when the original differential entered law). Having a payment differential based on provider size would be just another epicycle-like adjustment needed to make sense of the payer-centric universe.
Legislation that would return to the original intent of 1973 would put me - the dialyzor - at the center of my healthcare solar system. The goal should be my health, my optimal health. As long as we measure progress as spending 2% less on the provision of dialysis we will see an entrenchment of the status quo. The entrenchment of high speed, three day a week dialysis.
Rather than tut tutting about the over use of ESAs Congress would do better to concern themselves with the deadly under use of hemodialysis. I would love to see an end to the yearly inflation cut that is embedded in today's Medicare dialysis reimbursement but does the price have to be complicated changes that are to the advantage of large dialysis organizations? We can improve the dialysis program and support small dialysis providers. There is value in nonprofit healthcare, our legislation should support what little provider diversity remains.
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