October 16, 2018
1 min read

Legislators call on HHS to reconsider proposed cuts to access procedures

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Twenty-seven senators and representatives from both sides of the Congressional aisle signed a letter to HHS Secretary Alex Azar saying they oppose proposed Medicare payment cuts to vascular access services for patients on dialysis.

The Dialysis Vascular Access Coalition (DVAC), a consortium of medical specialty societies, physicians and non-hospital centers that provide vascular access services, said the payment cuts to some procedures are as high as 62%.

“If HHS finalizes this policy shift, patients will be impacted with respect to accessing vascular access services in the setting of their choice, receiving the appropriate level of high quality care based on their needs and failing to maximize the most cost-effective care,” the lawmakers wrote.

The letter to Azar was led by Reps. Ryan A. Costello, R-Pa., Debbie Dingell, D-Mich., and Leonard Lance, R-N.J.

The payment cuts, primarily for payment codes 36901 to 36909, are in the 2019 Ambulatory Surgical Center Proposed Rule for Patients with End-Stage Renal Disease and are aimed at vascular access procedures performed in ASCs. DVAC reports that one provision in the proposed rule would set vascular access reimbursement rates at the rate set in the physician fee schedule — “amounting to an unprecedented 62% cut on top of a staggering 37% reduction in the 2017 PFS,” they wrote in a press release about the proposed cuts. “Since the 2017 reduction was implemented, more than one in five physician offices have closed down according to a recent survey by the American Society of Diagnostic and Interventional Nephrology.”

The legislators also note in their letter that the payment rate for access services in ASCs is “an important guard” against the migration of outpatient procedures to the hospital setting, where costs to Medicare are higher. “By lumping the different levels of care – doctor’s office and ambulatory surgical centers – and setting this combined rate at the low end, CMS disincentivizes higher level care being provided in the most appropriate, and cost-effective setting,” they wrote.