[Congressional Record Volume 149, Number 60 (Saturday, April 12, 2003)]
[Extensions of Remarks]
[Page E779]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         ENSURE ACCESS TO CRITICAL DIALYSIS CARE UNDER MEDICARE

                                 ______
                                 

                         HON. GERALD D. KLECZKA

                              of wisconsin

                    in the house of representatives

                         Friday, April 11, 2003

  Mr. KLECZKA. Mr. Speaker, today Congressman Camp and I are 
introducing legislation, the Medicare Renal Dialysis Payment Fairness 
Act of 2003, which would require the U.S. Department of Health and 
Human Services (HHS) to create and implement by January 2004 an annual 
updating mechanism for dialysis reimbursement under Medicare.
  While the Medicare program pays for about 75 percent of dialysis 
care, there is currently no mechanism to update the reimbursement to 
account for inflation, new technology, labor, and other cost increases. 
In fact, the dialysis reimbursement is the only Medicare prospective 
payment system that does not have an updating framework. As a result, 
in their March 2003 Report to Congress, the Medicare Payment Advisory 
Commission (MedPAC) states that Medicare is on average paying three 
percent less than the cost of a dialysis treatment. This payment 
disparity is even greater for small and rural dialysis facilities, 
which experience about an 11 percent payment shortfall per treatment.
  A primary concern about this underfunding is the inability of 
dialysis facilities to compete with other providers--who do receive 
annual updates--for nurses and other health care workers. According to 
a study completed by Abt Associates, a dialysis center in Baltimore, 
Maryland is only able to pay $25.75 per hour while the local hospital 
has the resources to pay $35.00 per hour. Similarly, in northern 
California, a dialysis center pays staff $32.00 per hour while the 
hospital pays $40 per hour.
  Across the nation, nursing salaries have increased an average of 27 
percent (from $23,140 to $31,720) from 1992 to 2002. It has become more 
and more difficult for the renal community to keep up with these rising 
labor costs and recruit and retain trained staff for dialysis 
facilities when other providers have the capabilities to pay higher 
salaries.
  Even more importantly, reports show that low reimbursement rates have 
started to create access to care problems for Medicare end stage renal 
disease (ESRD) patients. In 2001, on average 77 percent of patients 
treated at renal facilities were Medicare beneficiaries. However, among 
the dialysis facilities that closed in 2001, Medicare beneficiaries 
comprised 88 percent of patients. This evidence indicates the economic 
challenge that dialysis centers face in treating Medicare 
beneficiaries.
  I am pleased that this legislation is supported by the Renal 
Leadership Council and the National Kidney Foundation.
  Mr. Speaker, providing for an inflationary annual update would allow 
the Secretary of HHS to make appropriate, data-driven decisions each 
year on fair dialysis payment rates. We must ensure that dialysis care 
for Medicare beneficiaries is not jeopardized due to inadequate 
reimbursement. I urge my colleagues to cosponsor and support this 
important legislation.

                          ____________________