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President's Message
NRAA President's Message to Members
Dear NRAA Members,
The renal community has come together to assist dialysis patients, employees and families devastated by Hurricane Katrina. The NRAA has been able, through special funding, to assist over 375 individuals. Additionally, the American Kidney Fund and the National Kidney Foundation have both been active in coordinating activities and grants to help those most in need. Please remember to send individuals in need to any of these organizations for further assistance.
As Maureen Michael has mentioned in several of her President's letters A.N.N.A. is spearheading an effort to match staff with facilities needing assistance. The website to apply is www.annanurse.org with the application available in our Members Only section, Report #564.
Hurricane Katrina devastated our Gulf Coast. Hurricane Stan ravaged Central America... hmm, we have a Katrina and a Stan on the NRAA Board of Directors; hopefully that is not an omen of the type of year the Association is going to have.
We are awaiting our next (un)natural disaster with the changes in our composite rate payment and the planned implementation of the new Wage Area Index (WAI). NRAA is very concerned with the large variations we are seeing from the current composite rate with the proposed WAI adjusted rates. In fact, in Ohio many providers are faced with a $10 to $15 per treatment reimbursement reduction. San Francisco, on the other hand, is getting a $20 increase. We do need to acknowledge the needs of higher cost communities, but providers cannot be expected to take a significant hit on their composite rate payments. It is a difficult situation compounded by the fact that our current WAI was implemented back in 1986 and needs to be revamped, but due to the budget neutrality provisions the dollars are taken from one provider to fund another provider.
With proposed major changes as discussed above it will be important to closely monitor the changes. We anticipate a final regulation to come out around November 1st with implementation for treatments on or after January 1, 2006. Not knowing how these changes will be implemented in their final form will require each of you to monitor information coming from NRAA. We will make every effort to give you the tools and the education on the impact to your facility.
We are now forming our committees for 2005 to 2006 and want to encourage members to sign up on the NRAA website to participate (Click here for a sign up form). This participation is important to help guide the NRAA and the Board of Directors to better serve your needs. Through this participation you will be able to qualify to run for one of our open Board positions when nominations open in the late spring of 2006. We encourage each of you to participate in the committees and consider running for the Board next year.
Several members have asked about an updated MMA calculator for use with the proposed regulations. Since the final regulations have not been issued we are going to hold off until the final regulations are out at the beginning of November to issue a new calculator. Bruce Thompson, who spent many hours in establishing the formulas for the old calculator, has agreed, along with the Finance Committee, to update the tool shortly after the regulations are issued. (I bet ours will be updated quicker than CMS's....)
Finally, I want to again ask the membership to please go to the NRAA website and use CapWiz to support the Kidney Care Quality Bill, if you have not already. This year, more so than in years past, remains a turbulent year in Congress and because of this we may still have an opportunity to add this important legislation to a Medicare bill. It will not happen unless each of you steps up and participates in support this bill through a note to your Congressman or through an invitation for them to visit your unit.
As with much of the industry, getting larger helps to better serve the members. The NRAA started the NRAA-GPO with the intent of providing better discounts and support to our members. I am pleased to announce that the NRAA-GPO is joining with Consolidated Purchasing Group to form the largest purchasing organization focused on dialysis and nephrology. The name of the new partnership will be called Renal Purchasing Group, LLC. Through this partnership the new company will continue the effort to provide improved contracts and services for the united membership. Members of both groups have been notified and you should see a seamless change going forward. If you have any questions please contact either: Michael Cooper, CPG at: 615-301-5960 or Chuck Halstenson, NRAA-GPO at: 866.672.2476.
Best Regards,
Tony Messana
NRAA President
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NRAA's Hurricane Disaster Relief Fund
Established to assist individuals (Patients and/or Staff) & Facilities
National Renal Administrators Association
Hurricane Disaster Relief Fund
A Hurricane Disaster Relief Fund has been established to assist individuals (Patients and/or Staff), Hospital Based and Independent Dialysis Facilities (Non Large Dialysis Organization) in need of financial assistance!
An online Application Form is available by clicking here.
For more information, please contact our National Office at:
(928) 717-2772 or email: nraa@nraa.org
Donations to the fund can be made by sending a check made payable to the National Renal Administrators Association and indicating Hurricane Disaster Relief Fund in the memo field of the check
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Help Support the Kidney Care Quality Improvement Act of 2005
Send a letter to your Senators or Representatives to get them to sign on
Earlier this year, the NRAA launched its grassroots communications program. The new program allows NRAA members to easily identify federal representatives and send them a letter requesting them to co-sponsor the "Kidney Care Quality and Improvement Act" (S. 635/H.R. 1298). The process takes less than five minutes. Since its inception, one hundred and twelve Representatives and nineteen Senators have signed on to co-sponsor this legislation. Representative Rick Boucher (VA) is the latest addition to the list of co-sponsors.
"The Kidney Care Quality and Improvement Act" contains numerous provisions important to the ESRD community, including a requirement that the composite rate be increased each year. In order to gain support for the bills and possible enactment this year, it is vital that NRAA members communicate with their Senators and Representatives and explain the importance of this legislation.
To use the new NRAA grassroots communications program, simply:
Go to http://capwiz.com/nraa/home/
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Click on the Action Alert box.
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Make sure to repeat the process for each version of the bill, one for the House and one for the Senate.
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Decide if you want to email the letter or print a copy to be mailed.
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Fill in the requested information (do this multiple times if you have more than one facility)
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Name, address, email address, be sure to add your zip code, as this will allow the system to find your U.S. Representative (for each facility, enter the zip code of the facility).
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You may edit the message to allow for any personal stories or specific facility information, or you can leave the message as is. Please make sure to keep the title of the bill and the bill number in the letter.
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After you hit "send message" a listing of your U.S Representative and Senators will appear.
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Please choose Health Care or its likeness as your subject matter in the drop down boxes for each official.
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Enter any other required information.
Email option
- If you have chosen the option to email, please hit the button to send the letter.
- Please check the box to send a copy to the NRAA.
Printed option
- If you have chosen the printing option, make sure all appropriate officials are selected.
- Choose the format you would like the letter to print in (word processor, text, or html).
- Print the letter and send it in the mail.
- Please send a copy of your letter to the NRAA, Attn: Mike Paget, 1904 Naomi Place, Prescott, AZ 86303-5061.
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Medicaid Commission Announces Next Meeting
To be held on October 26-27
The Medicaid Commission announced that it will hold its next meeting on October 26-27, 2005 in Washington, DC. The meeting will begin at 9:00 AM each day and will take place at the Holiday Inn on the Hill, 415 New Jersey Ave., NW.
The Commission will discuss options for making longer-term recommendations on the future of the Medicaid program that ensure long-term sustainability. Issues to be addressed may include, but are not limited to: Eligibility, benefit design, and delivery; expanding the number of people covered with quality care while recognizing budget constraints; long term care; quality of care, choice, and beneficiary satisfaction; and program administration. The Commission may discuss the need to divide into subgroups for the purpose of focusing on particular issues within this broad subject, including a discussion of which members would serve on which subgroup.
This meeting is open to the public. There will be a public comment period at the meeting.
The Federal Register notice announcing the meeting may be accessed online at: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/05-20189.htm
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Rates of Kidney Failure in US Have Stabilized
Average annual increase is less than one percent
According to a study by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), the rate for new cases of kidney failure has stabilized. The average annual increase has been less than one percent since 1999, compared to an average of five percent from the decade before. The leading causes of kidney failure remain high blood pressure, which accounts for 28 percent of all new cases, and diabetes, which accounts for 44 percent of new cases. There remain racial disparities with African Americans still reporting the same, rather than fewer, new cases of diabetes each year. Recent gains in clinical strategies seem likely to be responsible for the decrease in new cases of ESRD. Angiotensin-converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor blockers (ARBs) have played a role in preventing or delaying kidney failure. The use of such drugs has increased dramatically, almost doubling among the over sixty population, from 16 percent to 32 percent. The study found that tests used to find kidney disease at its earliest and most treatable stage are not often utilized. Only ten percent of the Medicare population had blood tests and only five percent had their urine tested for kidney disease. The results of the NIDDK study will be presented in November at the annual meeting of the American Society of Nephrology.
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New Medlearn Matters Articles Published
Temporary hold in claims from certain hospitals/dialysis facilities; Hurricane FAQ's
CMS recently published two Medlearn Matters Articles of interest to ESRD providers:
- Temporary Hold of Claims with HCPCS Codes G0369 or G0370 Received on or after October 1, 2005, from Maryland Hospitals and Non-OPPS and Dialysis Facilities - The article says, "Affected providers are advised that the Centers for Medicare and Medicaid Services (CMS) has instructed FIs to suspend and hold the following claims: Claims from Maryland waiver hospitals with dates of service on and after January 1, 2005, containing HCPCS codes G0369 or G0370; and Claims from other non-OPPS hospitals and dialysis facilities with dates of service on and after January 1, 2005 containing HCPCS codes G0369 or G0370 in revenue codes other than 0636."... "These claims are to be held until CMS can supply FIs with an October quarterly follow-up software release and the FIs have placed that software release in production. CMS has instructed the FIs to pay any applicable interest on these held claims that will be due as a result of his delay in processing the claims. FIs are to permit claims that contain G0369 and/or G0370 in revenue code 0636, that are not subject to the Maryland hospital waiver, to process payment."
The article may be accessed online at:
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0564.pdf
- Hurricanes Katrina and Rita - Frequently Asked Questions - Medicare Issues - The article contains important information about Medicare issues resulting from Hurricanes Katrina and Rita. CMS has posted pertinent information on its web site at http://www.cms.hhs.gov/hki.
The Medlearn Matters article may be accessed at: http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0563.pdf
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CMS Publishes New Transmittal
New Diagnosis Code Requirements for Method II Home Dialysis Claims
CMS recently published a transmittal of interest to the renal dialysis community:
- New Diagnosis Code Requirements for Method II Home Dialysis Claims, Pub 100-04 Medicare Claims Processing - Transmittal 701, Change Request 4095 - This change request revises diagnosis code requirements for Method II Home dialysis claims billed to durable medical equipment regional carriers (DMERC's).
The transmittal may be accessed online at: http://www.cms.hhs.gov/manuals/pm_trans/R701CP.pdf
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Guide to Rural Health Services Information Released
Medicare Guide to Rural Health Services Info. for Providers, Suppliers and Physicians
The "Medicare Guide to Rural Health Services Information for Providers, Suppliers and Physicians" is now available at the CMS website. The guide was developed by the CMS Division of Provider Information Planning & Development and offers rural health information and resources in a single source.
The guide may be accessed online at: http://www.cms.hhs.gov/medlearn/MedRuralGuide.pdf (note: this is a large file, 8MB, and may take awhile to load)
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Appropriations Process Could be Delayed Further
Both House and Senate are considering cuts to Medicaid and other programs
The Senate Finance Committee met with Senate Majority Leader Bill Frist (R-TN) to discuss possible cuts to the Medicare and Medicaid programs for Fiscal Year (FY) 2006. The committee is discussing various proposals for both programs. Committee Chair Charles Grassley (R-IA) presented $12 billion in savings over five years to Republican committee members, stating that his proposal would not affect health care service for beneficiaries, but he declined to give further detail. Grassley is also considering the addition of a prohibition on specialty hospitals. Grassley is also overseeing a bipartisan effort with Senator Max Baucus (D-MT) to expand the Medicaid program to accommodate the needs of Hurricane Katrina survivors. Senator Baucus has implied that he would not consider any cuts to the program until the Katrina Medicaid bill (S. 1716) passes.
House leaders have delayed the budget reconciliation for FY 2006 to October 28. A plan released by House Speaker Dennis Hastert (R-IL) instructs authorizing committees to reach a goal of $50 billion in savings from mandatory programs, which includes Medicaid and Medicare, at that time. House Budget Chairman Jim Nussle (R-IA) proposed a two percent cut to discretionary programs, including military programs.
The new Medicare prescription drug bill, set to begin on January 1, has been discussed as a possible target for spending cuts.
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CMS Publishes New Federal Register Notice
Exceptions for certain electronic prescribing and health records arrangements
CMS published a notice in the October 11 issue of the Federal Register announcing a proposed rule that would create an exception to the physician self-referral prohibition in section 1877 of the Social Security Act for certain arrangements in which a physician receives necessary non-monetary remuneration that is used solely to receive and transmit electronic prescription drug information. The rule also proposes two separate regulatory exceptions for electronic health records software and directly related training services. These exceptions are consistent with the President's goal of achieving widespread adoption of interoperable electronic health records for the purpose of improving the quality and efficiency of health care, while maintaining the levels of security and privacy that consumers expect.
The Federal Register notice may be accessed online at: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/05-20322.htm
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Medicare Assistance Program Extended
Legislation passes both houses of Congress
Last week, the House and Senate approved the Medicare Cost-Sharing and Welfare Extension Act of 2005 (H.R. 3971). The legislation would extend a program that covers some co-payments for low-income beneficiaries for one year, extend the Transitional Medical Assistance program until the end of the year, and provide Medicaid coverage to low-income families that have become employed since they began welfare assistance.
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Dialysis, Nephrology and Healthcare News (October 7 - 13, 2005)
Links to news items of interest to the Renal Manager
The following links are provided by  , the website for Nephrology News & Issues. KDEC '05 proceedings now available online! Go to www.nephronline.com
HURRICANE - Katrina leaves scientific research in ruins
NATIONAL - Medicare drug benefits outlined in campaign
NATIONAL -- Lawmakers push Bush to repeal Medicare Part D
NATIONAL -- Growth in new ESRD patients stabilizes
NATIONAL - Sorority rocks chairs for Kidney Foundation
NATIONAL – Lawmakers push plan to cut Medicaid costs
BUSINESS -- Consolidating Purchasing Group, NRAA-GPO merge
BUSINESS -- DCA announces completion of new mobile center
CLINICAL -- Mortality rates between single-use, reuse dialyzers similar, study says
CLINICAL -- CMS awards contract for multiple research studies to URREA
CLINICAL – New at-home dialysis gives hope
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