From SacBee.com, Sacramento Bee, California, by Kidney Care Partners
Nation's Kidney Care Community Says Medicare Rule Goes Too Far, Cuts Too Deep
Coalition Concerned That Phase-In Will Not Mitigate Impact on Patient Access and Care Quality
WASHINGTON, Nov. 23, 2013 /PRNewswire-USNewswire/ -- The nation's kidney care leaders today expressed disappointment that the Centers for Medicare and Medicaid Services' (CMS) decision to cut Medicare payments for dialysis by 12 percent – or nearly $30 per treatment – over three to four years will have a negative impact on vulnerable dialysis patients by threatening access to and limiting options for quality care.
The final Medicare rule does not change CMS' original proposal, issued in July, which also includes additional cuts of 12 percent.
According to Kidney Care Partners (KCP), a coalition of patients, physicians, nurses, providers, and manufacturers, the rule deals a significant blow to an already fragile system by ultimately reducing Medicare payments to a level that will not cover the cost of care for individuals on dialysis.
"Phasing in this cut does not solve the problem," said KCP Chairman Ron Kuerbitz. "Instead, it only delays the inevitable harm that will come as a result of failing to cover the cost of care. Simply put, this model is unsustainable."
As a result of the rule, KCP said, providers and physicians will face difficult choices regarding staffing, facility hours, quality improvement interventions, and ultimately whether an entire facility can be kept open to service a community. In turn, Medicare beneficiaries could face reduced access to care. [Read more]
From MedCityNews.com, by Reuters, 2013
Dialysis operators dodge proposed 9.4% rate cut from CMS
(Reuters) - Medicare, the U.S. government healthcare program for elderly and disabled people, will leave its overall reimbursement rates for kidney dialysis treatment unchanged for next year, and said it will take three to four years to implement a mandated adjustment to its base rates.
The 2014 payment rates are much less onerous than the 9.4 percent cut proposed by the agency in July.
The rates, announced on Friday by The Centers for Medicare and Medicaid Services (CMS), the federal agency that sets reimbursement rates for Medicare, come on top of a 2 percent reduction that kicked in earlier this year under automatic cuts to federal spending.
CMS said the final rule also finalized a 50 percent increase to home dialysis training payment adjustments. The agency said the rates reduce Medicare payments by 1.05 percent - the combined effects of an increase in the home health payment update percentage of 2.3 percent, offset by a decrease of 2.7 percent - the result of adjustments required by the Affordable Care Act - and a 0.6 percent decrease due to a refinement of the payment system.
Fresenius Medical Care AG, or FMC, and DaVita Healthcare Partners Inc are the largest dialysis providers in the United States.
FMC operates more than a third of the dialysis treatment centers in the United States and Medicare contracts account for about 30 percent of its revenues.
The industry had lobbied for more moderate cuts, arguing that lowering payments by 9.4 percent would force smaller operators out of business, hitting patient care mainly in rural areas.
The proposed reimbursement cuts for dialysis providers mainly reflect a drop in the use of the expensive hormone erythropoietin, or EPO, to treat anemia, a common side effect associated with dialysis.
Lower use of EPO came as a result of medical studies showing the dangers of overuse and after a new reimbursement regime was introduced in the U.S. that encouraged prudent use of EPO and more use of cheaper drugs that can partially substitute EPO.
FMC, indirectly controlled by a German charitable trust, derives about two-thirds of its total revenues from North America.
FMC launched a cost-cutting program at the beginning of the year in response to U.S. austerity measures, but it has not provided details.
(Reporting by Deena Beasley, additional reporting by Ludwig Burger; editing by G Crosse)
Kidney Donation Lessons
From NationalPost.com, by Robyn Urback, Canada Financial Post
When Canadians must resort to online ads to find themselves human organs for transplant, we might have a bit of a problem on our hands. Yet a Nova Scotia man took to online classifieds this month in a desperate attempt to find himself a new kidney. Ken Wilkie, who has polycystic kidney disease, posted an ad on Kijiji on November 7 under the title “Boost Your Karma.”
“I am a hard-working father of two, I don’t drink, smoke or do drugs,” Wilkie said in the post, “so I promise I will look after your kidney.” Wilkie received about 40 replies from people willing to get tested to see if they are a match before the ad was removed in accordance with the site’s terms of use.
Wilkie’s disease is genetic, meaning that his immediate family members are ineligible to donate. He did have a donor lined up, but tests revealed that the would-be donor had cervical cancer. Wilkie jokingly talked about putting an ad on Kijiji after receiving the news, and he decided later to follow through...
...In 2008, the Israeli Knesset passed new organ donation laws that gave transplant priority to patients who had signed their own donor cards. Living donors were also offered new compensation for lost wages and medical expenses. The change was accompanied by a massive public awareness campaign, which resulted in 70,000 new donors signing up in 10 weeks. According to Israel’s National Transplant Center, the number of transplants increased dramatically in 2011 — 68% over the previous year. That figure waned from 2011 to 2012, though Israel’s Health Minister Yael German is now pushing for the country to adopt an opt-out system.
Israel’s priority system should serve as a model to Canadian legislators in terms of exploring models beyond altruistic donation. Good karma is great, but a promise to jump the line should the potential donor become the recipient is even better — especially since Canada doesn’t grapple with the same sort of religious barriers to donation as does Israel. At the very least, it certainly beats Kijiji. [Read more]
PKD Research
From SceinceDaily.com
'Mini-Kidney' Structures Generated from Human Stem Cells for First Time
Now, a team of researchers led by scientists at the Salk Institute for Biological Studies has developed a novel platform to study kidney diseases, opening new avenues for the future application of regenerative medicine strategies to help restore kidney function.
For the first time, the Salk researchers have generated three-dimensional kidney structures from human stem cells, opening new avenues for studying the development and diseases of the kidneys and to the discovery of new drugs that target human kidney cells. The findings were reported November 17 in Nature Cell Biology.
Scientists had created precursors of kidney cells using stem cells as recently as this past summer, but the Salk team was the first to coax human stem cells into forming three-dimensional cellular structures similar to those found in our kidneys.
"Attempts to differentiate human stem cells into renal cells have had limited success," says senior study author Juan Carlos Izpisua Belmonte, a professor in Salk's Gene Expression Laboratory and holder of the Roger Guillemin Chair. "We have developed a simple and efficient method that allows for the differentiation of human stem cells into well-organized 3D structures of the ureteric bud (UB), which later develops into the collecting duct system."
The Salk findings demonstrate for the first time that pluripotent stem cells (PSCs) -- cells capable of differentiating into the many cells and tissue types that make up the body -- can made to develop into cells similar to those found in the ureteric bud, an early developmental structure of the kidneys, and then be further differentiated into three-dimensional structures in organ cultures. UB cells form the early stages of the human urinary and reproductive organs during development and later develop into a conduit for urine drainage from the kidneys. The scientists accomplished this with both human embryonic stem cells and induced pluripotent stem cells (iPSCs), human cells from the skin that have been reprogrammed into their pluripotent state. [Read more}
The final Medicare rule does not change CMS' original proposal, issued in July, which also includes additional cuts of 12 percent.
According to Kidney Care Partners (KCP), a coalition of patients, physicians, nurses, providers, and manufacturers, the rule deals a significant blow to an already fragile system by ultimately reducing Medicare payments to a level that will not cover the cost of care for individuals on dialysis.
"Phasing in this cut does not solve the problem," said KCP Chairman Ron Kuerbitz. "Instead, it only delays the inevitable harm that will come as a result of failing to cover the cost of care. Simply put, this model is unsustainable."
As a result of the rule, KCP said, providers and physicians will face difficult choices regarding staffing, facility hours, quality improvement interventions, and ultimately whether an entire facility can be kept open to service a community. In turn, Medicare beneficiaries could face reduced access to care. [Read more]
From MedCityNews.com, by Reuters, 2013
Dialysis operators dodge proposed 9.4% rate cut from CMS
(Reuters) - Medicare, the U.S. government healthcare program for elderly and disabled people, will leave its overall reimbursement rates for kidney dialysis treatment unchanged for next year, and said it will take three to four years to implement a mandated adjustment to its base rates.
The 2014 payment rates are much less onerous than the 9.4 percent cut proposed by the agency in July.
The rates, announced on Friday by The Centers for Medicare and Medicaid Services (CMS), the federal agency that sets reimbursement rates for Medicare, come on top of a 2 percent reduction that kicked in earlier this year under automatic cuts to federal spending.
CMS said the final rule also finalized a 50 percent increase to home dialysis training payment adjustments. The agency said the rates reduce Medicare payments by 1.05 percent - the combined effects of an increase in the home health payment update percentage of 2.3 percent, offset by a decrease of 2.7 percent - the result of adjustments required by the Affordable Care Act - and a 0.6 percent decrease due to a refinement of the payment system.
Fresenius Medical Care AG, or FMC, and DaVita Healthcare Partners Inc are the largest dialysis providers in the United States.
FMC operates more than a third of the dialysis treatment centers in the United States and Medicare contracts account for about 30 percent of its revenues.
The industry had lobbied for more moderate cuts, arguing that lowering payments by 9.4 percent would force smaller operators out of business, hitting patient care mainly in rural areas.
The proposed reimbursement cuts for dialysis providers mainly reflect a drop in the use of the expensive hormone erythropoietin, or EPO, to treat anemia, a common side effect associated with dialysis.
Lower use of EPO came as a result of medical studies showing the dangers of overuse and after a new reimbursement regime was introduced in the U.S. that encouraged prudent use of EPO and more use of cheaper drugs that can partially substitute EPO.
FMC, indirectly controlled by a German charitable trust, derives about two-thirds of its total revenues from North America.
FMC launched a cost-cutting program at the beginning of the year in response to U.S. austerity measures, but it has not provided details.
(Reporting by Deena Beasley, additional reporting by Ludwig Burger; editing by G Crosse)
Kidney Donation Lessons
From NationalPost.com, by Robyn Urback, Canada Financial Post
When Canadians must resort to online ads to find themselves human organs for transplant, we might have a bit of a problem on our hands. Yet a Nova Scotia man took to online classifieds this month in a desperate attempt to find himself a new kidney. Ken Wilkie, who has polycystic kidney disease, posted an ad on Kijiji on November 7 under the title “Boost Your Karma.”
“I am a hard-working father of two, I don’t drink, smoke or do drugs,” Wilkie said in the post, “so I promise I will look after your kidney.” Wilkie received about 40 replies from people willing to get tested to see if they are a match before the ad was removed in accordance with the site’s terms of use.
Wilkie’s disease is genetic, meaning that his immediate family members are ineligible to donate. He did have a donor lined up, but tests revealed that the would-be donor had cervical cancer. Wilkie jokingly talked about putting an ad on Kijiji after receiving the news, and he decided later to follow through...
...In 2008, the Israeli Knesset passed new organ donation laws that gave transplant priority to patients who had signed their own donor cards. Living donors were also offered new compensation for lost wages and medical expenses. The change was accompanied by a massive public awareness campaign, which resulted in 70,000 new donors signing up in 10 weeks. According to Israel’s National Transplant Center, the number of transplants increased dramatically in 2011 — 68% over the previous year. That figure waned from 2011 to 2012, though Israel’s Health Minister Yael German is now pushing for the country to adopt an opt-out system.
Israel’s priority system should serve as a model to Canadian legislators in terms of exploring models beyond altruistic donation. Good karma is great, but a promise to jump the line should the potential donor become the recipient is even better — especially since Canada doesn’t grapple with the same sort of religious barriers to donation as does Israel. At the very least, it certainly beats Kijiji. [Read more]
PKD Research
From SceinceDaily.com
'Mini-Kidney' Structures Generated from Human Stem Cells for First Time
Diseases affecting the kidneys represent a major and unsolved health issue worldwide. The kidneys rarely recover function once they are damaged by disease, highlighting the urgent need for better knowledge of kidney development and physiology.
Now, a team of researchers led by scientists at the Salk Institute for Biological Studies has developed a novel platform to study kidney diseases, opening new avenues for the future application of regenerative medicine strategies to help restore kidney function.
For the first time, the Salk researchers have generated three-dimensional kidney structures from human stem cells, opening new avenues for studying the development and diseases of the kidneys and to the discovery of new drugs that target human kidney cells. The findings were reported November 17 in Nature Cell Biology.
Scientists had created precursors of kidney cells using stem cells as recently as this past summer, but the Salk team was the first to coax human stem cells into forming three-dimensional cellular structures similar to those found in our kidneys.
"Attempts to differentiate human stem cells into renal cells have had limited success," says senior study author Juan Carlos Izpisua Belmonte, a professor in Salk's Gene Expression Laboratory and holder of the Roger Guillemin Chair. "We have developed a simple and efficient method that allows for the differentiation of human stem cells into well-organized 3D structures of the ureteric bud (UB), which later develops into the collecting duct system."
The Salk findings demonstrate for the first time that pluripotent stem cells (PSCs) -- cells capable of differentiating into the many cells and tissue types that make up the body -- can made to develop into cells similar to those found in the ureteric bud, an early developmental structure of the kidneys, and then be further differentiated into three-dimensional structures in organ cultures. UB cells form the early stages of the human urinary and reproductive organs during development and later develop into a conduit for urine drainage from the kidneys. The scientists accomplished this with both human embryonic stem cells and induced pluripotent stem cells (iPSCs), human cells from the skin that have been reprogrammed into their pluripotent state. [Read more}
From HealthCanal.com, By Duke Medicine News and Communications - DURHAM, N.C
An investigational, man-made blood vessel used in vascular grafts for kidney dialysis patients may potentially show encouraging early results among study patients in Poland, according to preliminary data reported Wednesday by a researcher at Duke Medicine.
Presented at the American Heart Association Scientific Sessions meeting in Dallas, the early findings of this interim patient data track 28 hemodialysis patients who received grafts using the investigational bioengineered vessel during a multi-center study launched in Poland last December.
The investigational bioengineered blood vessel, designed to be the first off-the-shelf product incorporating human tissue in the bioengineering process, provided blood flow in 100 percent of the study patients, reported Jeffrey H. Lawson, M.D., Ph.D., professor of surgery and pathology at Duke University School of Medicine. Eight patients later lost blood flow, but it was restored with interventions in each case.
Lawson said there is a significant need for alternative types of vascular technology. Current synthetic vascular grafts used for hemodialysis access provide initial blood flood in less than 50 percent of patients at six months, and with secondaryinterventions the success rates rises to 77 percent, Lawson said.
Preliminary interim analysis of the investigational bioengineered vessel currently being used for dialysis among the Polish patients has resulted in no infections to date, no immune reactions and no sign of structural degeneration.
“These early data are very encouraging,” said Lawson, who performed the first U.S. implantation of the blood vessel in June in a patient with end-stage kidney disease. [Read more]
