Kidney Care Partners Urges CMS to Change Proposed ESRD Rule to Address Payment Shortfalls on Labor and Innovation

August 1, 2023

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 urged critical reform to new policies introduced by the Centers for Medicare & Medicaid Services (CMS) in the End-Stage Renal Disease (ESRD) Prospective Payment System and Quality Incentive Program Proposed Rules.

“We appreciate the opportunity to share our concerns with the proposed rule, including barriers to innovation and inadequate reimbursement to cover growing labor costs,” said John P. Butler, chair of KCP. “KCP looks forward to working with the Administration to ensure that these policies improve, rather than undermine, the vital kidney care that patients need.”

In its comments, KCP emphasized that the market basket update in the proposed rule falls short of accounting accurately for healthcare inflation, particularly the substantial increase in the cost for nurses and other health care personnel that dialysis facilities face. KCP urged CMS to work with the kidney care community to address the problem immediately by adjusting the rate to reflect the difference between the initial projected forecast of cost increases and the actual increases that occurred. CMS already implements this type of policy for skilled nursing facilities.

Further, while KCP commended CMS for recognizing the community’s concerns about the need for additional money to be added to the payment rate for innovative drugs or biologicals that receive the Transitional Drug Add-on Payment Adjustment (TDAPA) when their TDAPA period ends, the proposed methodology fails to protect patient access to such products. KCP outlined its serious concerns about CMS’ intention to apply the new funding across all patients, not for those who medically require the product.  This policy results an allocation of only pennies to patients with less common conditions and would requires dialysis facilities to treat thousands of patients (a greater number than the average mid-size facility service) just to cover the cost for one patient who needs the drug.  Other troubling aspects of the proposal seek to cut the adjustment amount by an arbitrary 35 percent and limit new funding to only three years. Taken together, these policies will create a de facto loss of coverage for innovative treatment options for a group of patients who historically have had little access to innovation.

“We hope that CMS will carefully consider KCP’s recommendations and put patients first. Given that Medicare is the dominant insurer for most individuals with kidney failure, the program must include sufficient funding to cover the cost of the services provided. That means recognizing the cost of nurses and other health care professionals and incentivizing innovative treatment options. We look forward to continued work with CMS and hope the end policy result will provide changes in the payment system that reflect the needs of the kidney care community and support the delivery of high-quality care,” Butler concluded.

KCP’s full comments are available here.