Kidney Care Partners (KCP) – the nation’s largest non-profit, non-partisan kidney care coalition dedicated to protecting access and comprised of more than 30 organizations, including patients, dialysis professionals, physicians, nurses, researchers, therapeutic innovators, transplant coordinators, and manufacturers – today applauded Representatives Suzan DelBene (D-WA) and Larry Bucshon (R-IN), co-chairs of the Congressional Kidney Caucus as well as Representative Ami Bera (D-CA), Congressional Health Care Innovation Caucus co-chair, for urging the Centers for Medicare & Medicaid Services (CMS) to reduce Medicare barriers to innovative advancements in kidney care. The coalition also commended Representatives Mike Kelly (R-PA) and Terri Sewell (D-AL) for urging CMS to establish a forecast error adjustment in the final end-stage renal disease prospective payment system (ESRD PPS) for calendar year 2024.
In a letter to CMS Administrator Chiquita Brooks-LaSure, Reps. DelBene, Bucshon, and Bera outlined their concern that changes proposed in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) proposed rule do not sufficiently address barriers limiting patient access to new and innovative products.
“While we appreciate the importance of the current bundled payment system to promote high-quality and efficient care, we are skeptical that the proposed post-TDAPA add-on payments would, in many cases, sufficiently reimburse for new, innovative products,” the letter read. “For example, the proposed rule indicates that using available data for the current TDAPA product, CMS’ methodology would result in a nine-cent increase to the base rate for all dialysis patient claims, regardless of whether they use the product or not.”
A second letter to CMS, Reps. Kelly and Sewell raised concern about the significant impact the healthcare workforce shortage has had on dialysis providers and requested that a forecast error adjustment, similar to adjustments previously made for other prospective payment systems, be implemented to help address this problem. The letter also noted, “Although additional steps must be taken to improve the performance of the ESRD PPS payment adequacy, this immediate action is critical for Americans living with kidney failure.”
“All across the spectrum of kidney care, from providers to patients to innovators, there is a call for CMS to make policy changes to improve our kidney care infrastructure. Now we’re pleased to see members of Congress join our call for improvements to the rule,” said John P. Butler, Chair of KCP. “We thank these congressional champions of kidney care for their leadership and urge CMS to reexamine the ESRD PPS proposed rule to ensure that all Medicare beneficiaries with end-stage renal disease have access to innovations and life-sustaining care.”
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