[Congressional Record Volume 153, Number 33 (Tuesday, February 27, 2007)]
[Senate]
[Page S2277]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD:
  S. 691. 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, today I am pleased to introduce the Kidney 
Care Quality and Education Act. For the over 400,000 Americans living 
with kidney disease, the time has come to modernize and improve the 
Medicare End Stage Renal Disease (ESRD) program. They simply can't wait 
any longer.
  When Congress enacted the Medicare ESRD program, we recognized that 
this disease was unique and deserved special consideration. 
Unfortunately, since that time, Congress has fallen behind in its 
commitment, and the program has not kept pace with changes in 
treatment. My bill would take needed steps to modernize and improve the 
program to recognize quality and encourage education on kidney disease 
to better prevent and control ESRD.
  The Kidney Care Quality and Education Act 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, the bill seeks to 
establish uniform training requirements for dialysis technicians and to 
identify barriers to accessing the home dialysis benefit.
  Improving the ESRD program payment system and ensuring continued high 
quality care is also a critical component of modernizing the ESRD 
program. Medicare established the first prospective payment system 
(PPS) in the ESRD program in the early 1980s. Yet, the ESRD program 
remains the only Medicare PPS that does not receive an annual update. 
As a result, dialysis facilities have experienced difficulties in 
hiring qualified health care professionals and purchasing new 
technology.
  It is time for the dialysis community to receive annual payment 
updates; however, it is also critically important that increased 
payments are tied to high quality. My bill addresses both of these 
issues by creating a three-year Continuous Quality Improvement 
Initiative to link payments with quality. First, the three-year 
initiative would create an annual update mechanism to fairly pay 
providers. Second, it would ask providers to report on quality measures 
developed through consultation with key stakeholders. Finally, it would 
withhold a certain percentage of the annual update to fund a quality 
bonus pool from which payments would be made to those providers who 
provide the best quality of care.
  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 and 
Education 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.
                                 ______