ASN News

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Renal Week Credits

Forms are being processed in the order in which they were received, beginning with forms that were submitted onsite in Philadelphia, forms mailed by the December 2, 2005 deadline, and finally, forms that were mailed after December 2, 2005. Credits for the postgraduate education courses will be posted, followed by the annual meeting credits. All credits will be posted no later than February 28, 2006.

Centers for Medicare & Medicaid Services (CMS) Announces New Strategy for Anemia Management

After a prolonged delay, CMS announced in November a national strategy for monitoring claims for the drugs Epogen® and Aranesp^® for anemia management in patients with end-stage renal disease (ESRD) and who are dialyzed in renal facilities. ASN submitted comments independently, as well as collectively with the entire renal community, on the proposed policy revision.

The monitoring policy examines dosing levels of Epogen or Aranesp that are in line with the hematocrit/hemoglobin “target ranges” identified in the drug labeling approved by the Food and Drug Administration (FDA). Current industry guidelines for kidney disease call for maintaining the hematocrit level within a narrow target range of 33 to 36%. However, because many factors such as nutritional status, infection, and bleeding may cause the hematocrit to fluctuate, it is not easy to help patients remain within this narrow range. Some patients are above the target in one month and below it in another.

Under the new monitoring policy, CMS will initiate monitoring if the hematocrit reaches 39.0% (hemoglobin 13.0 g/dl). If the ESRD facility has reduced the dosage by 25% in the month where the starting hematocrit is above 39.0% (hemoglobin 13.0 g/dl), the facility must report this by using the modifier “GS” on the claim form. If the facility has not reduced the dosage, and there is no medical documentation to support the higher dosage, CMS will reduce payment to the level it would have been had the facility reduced dosage by 25%. In these circumstances, CMS will give the individual or entity the appropriate notice and an opportunity to appeal the determination under the existing appeals regulations.

The CMS monitoring policy also puts in place an edit for maximum dosage of Epogen and Aranesp in a single month. The maximum level for Epogen is 500,000 IU/month. For Aranesp, the maximum is 1500 μg/month.

“We are optimistic that this claims policy is going to meet our needs and the needs of Medicare beneficiaries,” said Barry Straube, MD, a nephrologist who is acting as the CMS Chief Medical Officer and also serving as the Acting Director of the CMS Office of Clinical Standards and Quality. The new monitoring policy will become effective for services rendered on or after April 1, 2006. More information may be found at https://www.cms.hhs.gov/coverage/8b5.pdf.

Demonstration Sites Selected for Beneficiaries with ESRD

CMS has selected two organizations to participate in a new demonstration that attempts to increase the opportunity for Medicare beneficiaries with ESRD to join managed care plans.

This demonstration has been designed to test the effectiveness of disease management models to increase quality of care for ESRD patients while ensuring that this care is provided more effectively and efficiently. CMS hopes to determine the benefits of disease management and care coordination for ESRD patients.

Medicare Advantage organizations and dialysis providers are partnering to offer health plans to beneficiaries with ESRD. The health plans will provide all Medicare-covered benefits with an emphasis on disease management and care coordination. Participating organizations were selected through a competitive process.

In the first year of the demonstration, the Medicare Advantage plans will be offered in four states (California, Pennsylvania, Texas, and Massachusetts) by DaVita and Fresenius, along with the Medicare Advantage partners. Coverage for enrolled beneficiaries began in November 2005.

An important aspect of this demonstration is the emphasis on quality improvement and pay-for-performance. CMS will reserve 5% of the capitation payment rates for incentive payments related to quality improvement. Participating organizations will receive payment for improvement on past performance and performing above the national averages for quality measures related to dialysis.

Further information on the CMS ESRD Disease Management Demonstration is available online at http://www.cms.hhs.gov/researchers/demos/esrd_demo.asp.

United States Senate Passes Health IT Bill to Encourage Electronic Record Use

By unanimous consent, the US Senate approved the proposed Wired for Health Care Quality Act (S. 1418), designed to encourage healthcare providers to adopt information technology (IT) and thus improve health care quality.

Senator Mike Enzi (R-WY) stated that the bill’s passage “brings us closer to enabling all Americans the freedom and security of going to the doctor’s office or hospital and presenting an electronic card or identification tag that holds all patient data, insurance, and medical history records.” Proponents of the bill also stressed that this technology would improve patient care by reducing medical errors and allowing for more efficient record keeping, thereby helping save lives.

The legislation would create a public/private American Health Information Collaboration panel, which would be charged with making health IT recommendations to the Department of Health and Human Services (DHHS) within a year of the bill’s enactment. The federal government would then have 60 days to act on the recommendations. DHHS has formed its own such panel, the American Health Information Community.

The bill also would provide grants to hospitals, group practices, and other healthcare providers to further the adoption of health IT; provide grants to health profession centers and academic health centers to incorporate health IT into clinical education; and establish a quality measurement system to reward healthcare providers who improve the quality of care that patients receive.

In October 2005, the leaders of two House healthcare panels introduced their own health IT legislation (H.R. 4157), the proposed Health Information Technology Promotion Act of 2005. The bill would codify the Bush administration’s national coordinator office for IT, create statutory safe harbors to allow hospitals and other providers to provide physicians with health IT software and hardware, and require DHHS to develop a health IT strategic plan. The House bill was introduced by House Ways and Means Health Subcommittee Chairwoman Nancy L. Johnson (R-CT) and House Energy and Commerce Health Subcommittee Chairman Nathan Deal (R-GA).