The Richmond Register

Viewpoints

March 27, 2013

Fiscal cliff health care fix: Good for rural patients

Rarely do federal lawmakers come upon a policy that can expand access to critical health care services and simultaneously save taxpayers money.

But according to a new report from the Congressional Budget Office (CBO), a tweak in the way Medicare pays for certain kidney disease drugs could do just that – preserving the availability of crucial treatments to rural patients and saving the program billions.

At issue is Medicare’s handling of a few “oral-only” dialysis medications designed for end-stage renal disease, the most severe version of chronic kidney disease.

In 2011, Medicare switched to a payment system that reimbursed for all dialysis-related treatments in one “bundled” rate. Instead of paying prevailing market prices, the government opted to compensate health care providers according to a formula.

But the Centers for Medicare and Medicaid Services – the government agency that oversees the program – decided to exempt certain oral dialysis medications from the bundle through 2014. January’s fiscal cliff deal extended the exemption through 2016.

Instead, those drugs will continue to be dispensed by local pharmacies through Medicare Part D, the prescription drug benefit.

That’s the right call. Setting appropriate compensation is a particularly time-consuming and complicated task. It requires a remarkable volume of medical data. If officials had simply thrown the oral dialysis treatment into the price-control bundle, they almost certainly would have set compensation too low.

Indeed, the Government Accountability Office explicitly warned of “a potential underestimate of the total cost” and said that there were still “questions about payment adequacy beginning in 2014.”

If policymakers had proceeded with bundling the oral dialysis medications, patients could have lost access to them. Health care providers serving the Medicare population would have started losing money when dispensing these drugs. Many would have been forced to stop offering them – leaving patients in the lurch.

Patients suffering from end-stage renal failure are some of the most vulnerable in the entire Medicare population. They typically require at least three rounds of treatment every week. Even minor disruptions to their health care regimens can lead to serious deterioration of their already fragile condition.

Those in rural areas would have been hit particularly hard. Many communities outside urban centers depend on just one or two health clinics to meet their medical needs. A single clinic may serve patients coming from 50 miles away or more. These clinics typically run on very thin profit margins and depend heavily on Medicare payments to stay afloat.

Aware of the potential adverse consequences in rural communities, legislators responded by maintaining these oral medicines under the Part D prescription drug benefit. This move helped to maintain the viability of small clinics servicing rural communities.

This was good for patient access but, according to the government budget accountants, also good for the Medicare program and taxpayers because it saves money. The CBO projects that extending the exemption through 2018 would save taxpayers approximately $1.3 billion.

Senators Max Baucus, D-Montana, and Orrin G. Hatch, R-Utah, played particularly important roles in marshaling support for the extension of the exemption through 2016, as part of the fiscal cliff deal earlier this year. They should be commended for championing the interests of rural Americans.

Because Congress acted in the best interests of rural patients, Medicare enrollees suffering from renal disease can now rest assured that they will retain access to treatments they need.

Grace Boatright is the legislative director for the National Grange, an organization that advocates for rural America.

1
Text Only
Viewpoints
  • 06.29 CrystalFarewell.jpg Starting over at Head Start

    All I ever wanted to be was a journalist. Having worked on my high school and college newspapers, I knew it was the career for me.
    I love talking to people, listening to their stories, being creative every day and experiencing new things. But as you know, news happens outside the hours of 9 to 5, and my job here at the Register rarely stayed within that time frame.

    June 29, 2014 2 Photos

  • Ike Adams They don’t make strawberries as they did back in the old days

    I’m not inclined to go through my archives at the moment, but it almost feels like the column I’m about to write has almost become an annual thing over the years.
    At least I know for sure that that this is not the first time that memories of picking strawberries there on Blair Branch on hot days in June has triggered this keyboard about this time of year.
    I grew up on a little subsistence, hillside farm deep in the mountains of eastern Kentucky, among the coalfields near the Virginia line.

    June 26, 2014 1 Photo

  • Ike Adams Baby boomers have let technology rob their grandchildren of the joys of youth

    When I was growing up, it was not uncommon to see fathers and sons along creek banks fishing together or in the woods hunting squirrels or pitching horse shoes or even shooting marbles late in the afternoon in the cool hours before dark.
    Dads were teaching kids to play the games they grew up with. Little girls, learned from mothers,how to skip rope, play with jacks or play hopscotch.

    June 12, 2014 1 Photo

  • Ronnie-Ellis.jpg No Lincoln or Douglas in this debate

    Remember the famous slap-down in the 1988 vice presidential debate when Republican Dan Quayle compared his youth and limited government experience to those of John Kennedy’s when Kennedy ran for president?
    His Democratic opponent, Texas Sen. Lloyd Bentsen, acidly replied: “I knew Jack Kennedy. Jack Kennedy was a friend of mine. Senator, you’re no Jack Kennedy.”

    June 7, 2014 1 Photo

  • Ronnie-Ellis.jpg Senate campaign already in full bloom

    Any hope for a respite in the U.S. Senate campaign following Tuesday’s primary disappeared immediately.
    Mitch McConnell and Alison Lundergan Grimes came out swinging in victory speeches which sounded like campaign kickoffs.
    McConnell commended Matt Bevin on “a tough (primary) race” and appealed to Bevin supporters to unite behind his re-election bid. That will be hard for Bevin and those who backed him.

    May 24, 2014 1 Photo

  • Jim Waters.JPG ‘Taxpayer-eaters’ meet ‘self-serving politician-eaters’

    What some candidates could gain in this year’s election – beyond just winning office – is a stark reminder of how wrong political leaders were when declaring last year they had adequately addressed Kentucky’s public-pension crisis.
    Instead, legislators with serious courage deficiencies failed to agree on reforms beyond what they believe are “politically feasible.”

    May 16, 2014 1 Photo

  • Ike Adams Step Out, Step up for Diabetes Association

    Six weeks ago when I wrote here announcing the 2014 Edition of Team TKO’s American Diabetes Association, Step Out Walk Team, several dozen of you readers sent generous donations to sponsor grandson Tyler Kane Ochs (TKO) and me in the walk that takes place, rain or shine, in the mud or not, at Keeneland on the morning of May 31.
    Another several dozen of you either called, emailed or dropped a card in regular mail and asked that I remind you again “after the holidays” (Easter and Mother’s Day).

    May 16, 2014 1 Photo

  • Ronnie-Ellis.jpg Hitting the campaign trail

    The most watched race in the country ? the battle for the U.S. Senate seat now held by Republican Mitch McConnell ? has so far produced a bevy of charges and not much substance.
    We haven’t seen that much of McConnell or his likely Democratic opponent Alison Lundergan Grimes out on the campaign trail.
    McConnell’s primary opponent Matt Bevin has been much more active and visible, but his performance hasn’t enhanced his chances.

    May 11, 2014 1 Photo

  • The case of the scary black cat

    If Margie didn’t believe that black cats were the harbinger of bad luck, she certainly believed it when a black cat brushed against her leg while she was leaning over a large trash can burning garbage one late afternoon.
    Startled by the sudden appearance of the feline, Margie opened her mouth wide and let out a blood-curdling scream that could have awakened Count Dracula himself.

    May 10, 2014

  • Ike Adams Basking in the spring sunshine

    If you had asked me, as recently as two weeks ago, to make a list of things I expected to see on the first Monday in May of 2014, two of the things that I actually did see would not have been on the list, even if you’d required that it contain at least 500 items.
    I’d have been a bit skeptical about Ralph’s purple asparagus and his gorgeous snowball bush, both of which came through most admirably. And I would have had my doubts about the poppies that have been in our back yard for several generations and the bearded German Iris that Jeanette Todd gave us more than two decades ago. It faithfully stuns us there at the corner of the front porch every spring, but there they were, basking in absolute glory as the sun set Monday afternoon.

    May 8, 2014 1 Photo

AP Video
Couple Channel Grief Into Soldiers' Retreat WWI Aviation Still Alive at Aerodrome in NY Raw: Rescuers at Taiwan Explosion Scene Raw: Woman Who Faced Death Over Faith in N.H. Clinton Before 9-11: Could Have Killed Bin Laden Netanyahu Vows to Destroy Hamas Tunnels Obama Slams Republicans Over Lawsuit House Leaders Trade Blame for Inaction Malaysian PM: Stop Fighting in Ukraine Cantor Warns of Instability, Terror in Farewell Ravens' Ray Rice: 'I Made a Huge Mistake' Florida Panther Rebound Upsets Ranchers Small Plane Crash in San Diego Parking Lot Busy Franco's Not Afraid of Overexposure Fighting Blocks Access to Ukraine Crash Site Dangerous Bacteria Kills One in Florida Workers Dig for Survivors After India Landslide Texas Scientists Study Ebola Virus Smartphone Powered Paper Plane Debuts at Airshow Southern Accent Reduction Class Cancelled in TN
Hyperlocal Search
Premier Guide
Find a business

Walking Fingers
Maps, Menus, Store hours, Coupons, and more...
Premier Guide
Poll

Should Madison County’s three local governing bodies ban smoking in indoor public places?

Yes
No
     View Results