[Congressional Record Volume 151, Number 32 (Wednesday, March 16, 2005)]
[Senate]
[Page S2849]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SANTORUM (for himself, Mr. Conrad, and Mrs. Murray):
  S. 635. A bill to amend title XVIII of the Social Security Act to 
improve the benefits under the medicare program for beneficiaries with 
kidney disease, and for other purposes; to the Committee on Finance.
  Mr. CONRAD. Mr. President, I rise today in support of the Kidney Care 
Quality Act, which Senator Santorum and I introduce today. With all of 
the attention now being paid to improving the quality of health care 
Americans receive, we believe it is important for Congress to reaffirm 
our commitment to patients with kidney failure.
  As part of this commitment, Congress should ensure that these 
patients receive high quality care and should take steps to improve the 
Medicare End Stage Renal Disease, ESRD, program. This bill would do 
just that. First, it establishes a quality demonstration project to 
reward high quality dialysis providers. It also establishes education 
programs to assist patients with kidney disease to learn important 
self-management skills that will help them manage their disease more 
effectively and improve their quality of life. The bill also seeks to 
help individuals before they develop irreversible kidney failure by 
teaching individuals about the factors that lead to chronic kidney 
disease, the precursor to kidney failure, and how to prevent it, treat 
it, and, most importantly, avoid it.
  Additionally, we recognize that some patients who currently receive 
dialysis in dialysis facilities and hospitals could benefit by 
receiving the treatments in their homes. Even though home dialysis can 
improve patients' quality of life by allowing them to remain employed 
and to participate in other activities that promote well-being, only a 
small number of patients select the home dialysis option. According to 
the U.S. Renal Data System, less than one percent of all ESRD patients 
relied on home dialysis in 2001. The bill we are introducing today 
would require the Department of Health and Human Services to identify 
barriers patients face in choosing home dialysis benefits and take 
steps toward eliminating them.
  Improving the ESRD program payment system is also a critical 
component of promoting high quality care for patients with kidney 
failure. Medicare established the first prospective payment system, 
PPS, in the ESRD program in the early 1980s. Since that time, we have 
learned a great deal about how the PPS methodology works. Yet, the ESRD 
program remains the only Medicare PPS that does not receive an annual 
update. As a result, dialysis facilities have difficulty hiring 
qualified health care professionals because they simply cannot match 
the salaries offered by hospitals and other providers that do receive 
an annual update. For 2005, MedPAC has calculated a projected margin on 
dialysis services of -0.03 percent when combining the composite rate 
and injectible drugs. Without a fair reimbursement rate, providers face 
significant hurdles in attracting high quality health care 
professionals. Our bill addresses this ongoing problem to ensure that 
providers receive fair payment for the services they provide.
  Congress must reaffirm its commitment to Americans with kidney 
failure by improving the program through new educational programs, 
quality initiatives, and payment reform. The Kidney Care Quality Act is 
a comprehensive bill that moves the program in that direction. I urge 
my colleagues to join with me in supporting this important legislation.
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