Congressional Corner – January: Over the cliff – then quickly back up again

By Carrie L., Director of Congressional and State Relations

C blog photo

Well, we went over the fiscal cliff. And then, just hours later a deal was struck, a few hours late but a deal to bring us back from the brink nonetheless. The 112th Congress concluded its tumultuous, and gridlocked 2 years by passing a deal to avoid massive tax hikes for the middle class and a 27% decrease in payments to Medicare providers on New Year’s Day. Unfortunately, cuts to the Medicare ESRD program were still included in the fiscal cliff package. The deal calls on the Centers for Medicare and Medicaid Services (CMS) to reduce the bundled payment rate for dialysis services to reflect the recent changes in the use of certain medications over the past several years. The bundled payment rate will be “rebased” to more accurately reflect the changes in drug usage and drug prices starting in 2014. Additionally, the inclusion of oral-only medications in the bundle will be delayed until January 1, 2016.

Oral medications were scheduled to roll into the bundle for payment on January 1, 2014. This delay gives DPC and the kidney community more time to ensure that the inclusion of these medications is done appropriately and in the best interest of patients. The government estimates the savings from rebasing will reach $4.9 billion over the next 10 years. A further $300 million in cuts were made to Medicare payments for non-emergency ambulatory transportation for ESRD patients to dialysis facilities.

So comes to a close the term of the 112th Congress. DPC will continue its work with the 113th Congress and with CMS to make sure that dialysis patients and their benefits are not harmed by these or any cuts and to ensure that patients have access to the highest quality care possible. Here’s hoping the 113th Congress has a better go!


  1. Thanks for the update, in plain English! Very helpful. Best of New Years to you. (P.S. As a sidenote, I recently had it out with my doctor about substituting iron for EPO – he drove my hemoglobin to 13 and I felt like I was on speed, he switched me from EPO to iron without discussing it, and ordered 8 consecutive tubes of iron.) If the iron had seeemed alright, I would not have argued, but it felt wrong, so after quite a fight, I was switched back to EPO. Must fight for your rights as a patient. With dialysis, that never ends.

  2. phyllis cleary says:

    What does this mean for IV antibiotics. For serious reasons I am on Vanco for LIFE. My Drs don’t want to take a chance by taking me off. My aortic graft may rupture AGAIN. Been through the TAAA surgery 2 times and don’t think I could.survive 3. Any info sent to me appreciated. Thanks for your informative update.

  3. Hi Phyllis! Thank you for your question! IV antibiotics are paid out of the bundle but this rebasing should not affect your access to them. Congress instructed CMS to use more recent data on drug prices and drug usage to update the payment amount for each treatment. So CMS will also be taking into consideration the price of these IV antibiotics (as well as many other drugs) and this amount should be included in the final payment. As I mentioned in the post above, the government expects $4.9 billion in savings over 10 years based on rebasing, but is not held to this number (most of this savings they seem to think will come from decreases in ESA usage). So in reality, after taking into account all of the changes, the actual savings might be less.

  4. Great job Carrie! But I should have expected that, eh? Thanks for your perspective. I put a link to this article in tomorrow’s blog post. My readers will want to see this. Have a great 2013!


  1. […] More about the “fiscal cliff” issue from Dialysis Patient Citizens.  Read it at… And here’s another very good posting about this from Renal Business Today […]

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: