Warning: __________ in the Road Ahead
It is still too soon to tell what word(s) we will use to fill in the blank to describe what awaits us as we speed toward 2005. Whether it will be a bump, pot hole, sink hole, or just uneven pavement, one thing you can count on is that the environment in which we work will be changed forever.
The warning signs have been posted for some time:
- Skyrocketing health care costs consuming more of our federal and state tax dollars, but quality of care is in question.
- An aging population and rising numbers of individuals with diabetes, hypertension, and obesity.
- Increasing focus on outcomes.
- Increasing numbers of under or uninsured citizens.
How many of us have noticed?
In October I attended the annual meeting of the National Renal Administrators Association (NRAA) to hear the latest about how dialysis providers anticipate the Medicare Modernization Act (MMA) will impact dialysis services. The Act is being touted as one of the first major revisions to the Medicare Program since its inception in 1965! The massive Act mandates an overhaul of the Medicare program, including authorization of special needs health plans and prescription drug and new preventive benefits.
Signed into law at the end of 2003, the MMA has charged the Centers for Medicare and Medicaid Services (CMS) with the enormous task of implementing it. As statutorily required, on August 5, CMS published for comment the Notice of Proposed Rule Making (NPRM) for Payment Policies under the Physician Fee Schedule for Calendar Year 2005. The proposed rule sets forth major changes in the way Medicare will pay for dialysis treatments and drugs. Dialysis providers, large and small alike, are scrambling to determine how their reimbursement will be affected.
On September 24, ANNA, as a member of Kidney Care Partners (KCP, an alliance of renal patient advocates, dialysis care professionals, providers, and suppliers), signed on to KCP’s letter of response to the proposed rules. In addition, ANNA submitted its own comments. (These documents can be found on ANNA’s Web site. Go to www.annanurse.org, click on Health Policy, and click Legislative Activities.) The final revised rules will be published in November, and implementation will take place in January 2005.
What do these changes mean for nephrology nurses who care for patients with chronic kidney disease? I am not an expert, but I believe that the anticipated reduction in reimbursement will impact staffing and the way we deliver care to our patients.
How can we prepare for the changes ahead? I suggest that we:
- Learn as much as we can about the MMA and the proposed rules that impact the ESRD program. (For more information, go to the discussion board entitled “CMS Proposes Reimbursement Changes for ESRD for 2005” on the RenalWEB site at http://www.renalweb.com/ubb/Forum15/HTML/000578.html)
- Continue our grassroots efforts to educate lawmakers about chronic kidney disease and to support KCP’s ESRD Modernization legislation. (Read more about this legislation on the KCP Web site at http://www.kidneycarepartners.org/index.php/activities/legislative.html)
- Assist patients to understand the changes and encourage them to actively make their concerns known to their legislative representatives.
What other changes can we expect in 2005? In addition to those changes described above, the long awaited revised Conditions of Coverage for the ESRD program are rumored to be released for public comment in late November. And on top of these policy changes we face a nursing shortage that is expected to worsen between 2005 and 2010.
Our specialty does not stand alone in facing these changes. All health providers and organizations are responding to the health care shift toward transparency, accountability, and value orientation as well as the reality of fewer health care professionals.
An example of this shift is apparent in the recent CMS announcement of a demonstration project for Care Management for High-Cost Beneficiaries. “A relatively small number of people on Medicare, many of whom are very ill, account for most of our spending. A modern health care system needs to find opportunities to improve their lives,” said CMS Administrator Mark B. McClellan, MD, PhD. “We’re going to find the most promising, innovative approaches. And we’re going to provide financial rewards for lower costs and better quality.”
Don’t be surprised at the changes you see in 2005. Be prepared by being informed.
Suzann VanBuskirk, BSN, RN, CNN