Nephrologists see regulatory, legislative wins, more work ahead
DALLAS — After uncertainty a year ago from a leadership void at HHS, nephrology practices and kidney research are seeing benefits from recent legislative and regulatory victories, according to a speaker at the Renal Physicians Association Annual Meeting.
“A year ago, we were in the early days of the Biden Administration,” Robert Blaser, director of public policy for the RPA, said, here. “There was a lot of uncertainly this time last year.”
With vacancies at HHS and CMS, it was unclear whether newly proposed payment models were going to stay or be implemented. In 2021, the Biden Administration appointed Xavier Becerra as the new HHS secretary and Chiquita Brooks-LaSure as the new CMS administrator. New appointments were also made to the CMS Innovation Center, leading to assurances that demonstrations like the ESRD Treatment Choices model, which was launched in January 2021, and the Kidney Care Choices demonstration, which launched in January 2022, would go as planned.
“[There was] much uncertainly, not just at HHS, but everywhere,” Blaser said.
Blaser said several goals for the nephrology community on Capitol Hill during the past year that still require legislative action in 2022, include:
- Living Donation Protection Act, which would disallow health insurance companies to increase rates on coverage for individuals who donated an organ;
- Connect Act, which permanently removes the originating site and geographic restrictions for telehealth visits;
- Omnibus Kidney Health initiative that offers several benefits to the kidney care community; and
- Improving Access to Home Dialysis Act, which would provide Medicare funding to pay for patient support during home dialysis for up to 90 days.
Blaser said the Connect Act would require quarterly home dialysis visits, which the RPA favors.
“We think it is bad for patient care and bad for future policy” to not require a minimum number of visits between nephrologists and home dialysis patients, he said.
Blaser said some positive funding steps for kidney projects were approved by Congress when legislators passed the $1.5 trillion Omnibus Reconciliation Act of 2022 on March 9, including:
- $5 million for the KidneyX prize competition for innovative devices in kidney care;
- An additional 3.3% provided to the National Institute of Digestive and Diabetic Kidney Diseases to run the Kidney Precision Medicine Project, and
- $3.5 million for funding kidney disease surveillance and awareness projects for the CDC.
The National Living Donor Assistance Center received $7 million to continue to provide financial support to living donors and their families, Blaser said. The center provides reimbursement of travel and expenses, lost wages and dependent care expenses to people being evaluated for and/or undergoing living organ donation and is administered by the Division of Transplantation and other federal agencies through a cooperative agreement with the University of Kansas and the American Society of Transplant Surgeons.
Nephrologists received good news last year when the final rule of the Medicare Fee Schedule included an 11% increase in payments to nephrologists after lobbying efforts by the RPA and the American Society for Pediatric Nephrology.
“This was $270 million that came to the specialty that would not have come otherwise,” Blaser said.
For 2022, Blaser said payments for vascular access procedures completed in office space surgical labs were reduced. The cuts occurred because of changes in how CMS covers labor costs.
“It’s about a 5% cut this year and each year for the next 4 years,” he said.
The RPA lobbied successfully to have the cuts spread over the 4 years.
With major events like the battle in Ukraine and other legislative priorities, Blaser said movement on bills like the Improving Access to Home Dialysis Act would require larger health care-related legislation to move forward.
“The supporters of the bill understand it will be some time before there is action taken on this bill,” Blaser said. “It may require a larger Medicare bill for this to move forward.”