Policy & Regulation News

Senate Finance Committee, NKF Address Medicare Spending

By Jacqueline DiChiara

- The vast majority of Medicare dollars – 93 percent – accounts for chronic illness. As reported by RevCycleIntelligence.com, a recent legislative proposal from the Senate Finance Committee aims to dramatically improve care for rurally-based Medicare beneficiaries with chronic conditions. 

chronic conditions

In response to the Senate Finance Committee’s plans, the National Kidney Foundation (NKF) released a statement praising the needed attention now placed upon uncoordinated and expensive chronic health conditions, such as the “virtually unknown” chronic kidney disease (CKD).

RevCycleIntelligence.com spoke with Tonya Saffer, MPH, Senior Health Policy Director of the National Kidney Foundation, for further clarification on the far reaching financial significance of the Senate Finance Committee’s initiatives and how to effectively curb healthcare costs.

Saffer confirms NKF’s objective for collaborating with the Senate Finance Committee is to ensure resulting legislation addresses the severe gap present within CKD diagnosis, management, and awareness. Early detection of CKD can prevent comorbidities and reduce adverse events such as heart attacks, thus slowing growth in healthcare expenditures. In addition, research shows that diagnosis of CKD is associated with increased patient awareness, which can spur greater patient self-management, says Saffer. Currently, 10 percent of the 26 million Americans with CKD are aware they have the disease, she maintains.

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  • “Solutions coming out of the Senate Finance Committee workgroup are likely to look towards new healthcare payment models, and this is in light of HHS just announcing they want to move 50 percent of Medicare payments away from fee-for-service and into more advanced payment and delivery models by 2018,” Saffer states. “Some of these new payment models, such as the primary care medical home and Accountable Care Organizations have been shown to lower costs and improve care coordination amongst Medicare beneficiaries,” she explains.

    Avoiding adverse events, such as heart attacks, stroke, acute kidney injury, temporary kidney failure, or drug toxicity, through early management in the primary care setting is cost effective, says Saffer. “Avoiding these outcomes and slowing CKD progression from one stage to the next can slow the growth in Medicare expenditures of CKD, which is currently at $87 billion dollars,” she maintains.

    Saffer says although some Medicare payment models have been successful, such as the Medicare Accountable Care Organizations (ACOs), some reduce costs without enhancing care quality. “More will need to be done in the long term to improve quality and further drive cost savings in those programs. I think that building on those models might be a direction to take into account,” Saffer confirms. “There remains a need to coordinate better care amongst patients' providers and drive incentives to earlier detect chronic conditions and start treating them before they multiply,” she adds.

    Kidney disease, she says, serves as a solid baseline as a disease multiplier. It increases the risk of other chronic conditions. Therefore, the active promotion of early diagnosis efforts is essential to advance the healthcare industry, she states.

    “With an aging Medicare population and more people developing chronic conditions at a younger age and then entering Medicare coverage with those chronic conditions, you're naturally going to see more spending on chronic conditions,” Saffer says. “However, realigning payment for healthcare to incentivize identifying those conditions early on, like kidney disease, and taking a multipronged approach to management that includes things like nutrition counseling, medication management, and delivering patient-centered care, can really curb those costs," she explains.

    NKF has been talking with the Centers for Medicare & Medicaid Services (CMS) about the need to incorporate early detection and management into new health payment models, confirms Saffer. 

    “Following the passage of the Affordable Care Act, CMS has the authority to make alternate payment models tested at the Center for Medicare and Medicaid Innovation permanent, to extend them, to grow them,” Saffer explains. “Now that we're about four years into some of these payment models, they're probably getting results and lessons learned, and now we're really ready to take that next step,” maintains Saffer.

    Early intervention is essential to improving outcomes, maintaining economically sound healthcare costs, and enhancing overall patient experience, states Saffer. “We look forward to working with the Senate Finance Committee and its working group to craft policies to address CKD and chronic disease care and spending,” she confirms.