Dear Members of the Joint Select Committee on Deficit Reduction:
NxStageUsers is a non-profit organization whose mission is to support patients with End Stage Renal Disease (ESRD) and to advocate for optimal treatment and rehabilitation. In a mere four years, NxStageUsers has grown into the largest group of home dialyzors whose members consist of kidney patients and care partners.
On behalf of those members, we are writing to both congratulate you on your appointment to an all important committee and to also share our patient centered ideas on deficit reduction.
Although our recommendations may somewhat echo those of other kidney organizations, our comments stem not from a corporate big business viewpoint but from the unique perspective of living with kidney failure every single day. Being an independent organization, we are focused totally on patient outcomes.
The original intent of the 1972 ESRD Medicare legislation was to create rehabilitated, employed patients. Unfortunately, rather than fulfilling that noble goal, most patients have been channeled into disability and perceived helplessness. Therefore, NxStageUsers proposes the following measures.
- Across the board reductions should be avoided.
- Due to the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA), the kidney community is still enmeshed in major changes to dialysis, including the new Prospective Payment System (PPS). ESRD patients have already seen the effects of reductions in reimbursements. An additional 2% reduction would further compromise patient care and optimal outcomes.
- Dialysis patients are especially vulnerable, since more than 40% of dialysis patients are also eligible for Medicaid. States are reducing reimbursement for that program, as well.
- Other governmental bodies that affect dialysis patients, such as VA and AHRQ would be adversely impacted by across the board cuts.
- Most importantly, NxStageUsers urges the committee to include the Medicare Secondary Payer (MSP) in any Health Insurance Exchanges. This measure alone is estimated to create a $6 billion savings over ten years. Retaining the MSP means that patients who develop kidney failure while in an Exchange would have the same option of continuing private insurance for 30 months.
- In addition, NxStageUsers recommends that the committee ties the continuation of the MSP to specific patient rehabilitation outcomes, such as patient employment for those 18-54 years of age. This stipulation would ensure that additional monies garnered from billing private insurance would be funneled into patient care rather than into additional corporate profit. Employed patients pay taxes and do not draw disability payments, a further source of savings. We recognize that allowances must be made for those who are unemployed through no fault of their own, such as layoffs or business closings.
We appreciate the challenges the committee faces and we thank you for your time.
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