The Honorable Kent Conrad (D-ND)
February 27, 2007

S. 691. A bill to amend title XVIII of the Social Security act to improve the benefits under the Medicare program for beneficiaries with kidney disease, and for other purposes; to the ommittee on Finance.

Mr. CONRAD. Mr. President, today I am pleased to introduce the Kidney Care Quality and Education Act. For the over 400,000 Americans living with kidney failure, the time has come to modernize and improve the Medicare End Stage Renal Disease (ESRD) program. They simply can’t wait any longer.

When Congress enacted the Medicare ESRD program, we recognized that this disease was unique and deserved special consideration. Unfortunately, since that time, Congress has fallen behind in its commitment, and the program has not kept pace with changes in treatment. My bill would take needed steps to modernize and improve the program to recognize quality and encourage education on kidney disease to better prevent and control ESRD.

The Kidney Care Quality and Education Act establishes education programs to assist patients with kidney disease to learn important self-management skills that will help them manage their disease more effectively and improve their quality of life. The bill also seeks to help individuals before they develop irreversible kidney failure by teaching individuals about the factors that lead to chronic kidney disease, the precursor to kidney failure, and how to prevent it, treat it, and, most importantly, avoid it. Additionally, the bill seeks to establish uniform training requirements for dialysis technicians and to identify barriers to accessing the home dialysis benefit.

Improving the ESRD program payment system and ensuring continued high quality care is also a critical component of modernizing the ESRD program. Medicare established the first prospective payment system (PPS) in the ESRD program in the early 1980s. Yet, the ESRD program remains the only Medicare PPS that does not receive an annual update. As a result, dialysis facilities have experienced difficulties in hiring qualified health care professionals and purchasing new technology.

It is time for the dialysis community to receive annual payment updates; however, it is also critically important that increased payments are tied to high quality. My bill addresses both of these issues by creating a three-year Continuous Quality Improvement Initiative to link payments with quality. First, the three-year initiative would create an annual update mechanism to fairly pay providers. Second, it would ask providers to report on quality measures developed through consultation with key stakeholders. Finally, it would withhold a certain percentage of the annual update to fund a quality bonus pool from which payments would be made to those providers who provide the best quality of care.

Congress must reaffirm its commitment to Americans with kidney failure by improving the program through new educational programs, quality initiatives, and payment reform. The Kidney Care Quality and Education Act is a comprehensive bill that moves the program in that direction. I urge my colleagues to join with me in supporting this important legislation.

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The Honorable John Lewis (D-GA)
February 27, 2007

Mr. LEWIS of Georgia. Madam Speaker, I rise in support of the Kidney Care Quality and Education Act that I am proud to introduce today with my colleague from Michigan, Mr. CAMP. This comprehensive legislation will help educate Americans about how to prevent and delay the onset of kidney disease and ensure high quality care for patients with irreversible kidney failure.

More than 400,000 Americans have kidney failure, which is also known as End Stage Renal Disease (ESRD). The only treatment available to these patients is a kidney transplant or renal dialysis. Because there are so few kidneys available for transplantation, most dialysis patients must undergo 3-hour treatment sessions three to four times per week.

Diabetes and hypertension are two of the leading causes of kidney disease. We continue to see the numbers of Americans with these conditions rise, and as a result, we will continue to see more Americans suffering from chronic kidney disease. Statistics show that African Americans are particularly at risk for kidney disease and kidney failure. They make up more than one third of all patients on dialysis in this country. Most alarming, the growth rate of kidney failure among African Americans age 30 to 39 has risen 26 percent since 2000 and it shows no signs of stopping. African Americans have a higher risk of developing the conditions that lead to kidney failure. For example, the American Heart Association reports that more than 40 percent of African Americans have hypertension. African Americans with diabetes experience kidney failure about four times more often than white Americans with diabetes. In addition, African Americans
are less likely to receive treatment in the early stages of the disease or to learn about how they can slow the progress of kidney disease.

The Kidney Care Quality and Education Act will help address these issues by improving public awareness about kidney disease and improving access to quality care. The importance of educating our citizens about kidney disease cannot be understated. The Kidney Care Quality and Education Act will provide funding to establish critical educational programs to increase public awareness about kidney disease treatment and prevention. These programs will also help people already suffering from chronic kidney disease and kidney failure, by providing important self-management skills that will improve their quality of life and help them continue their normal activities,
such as working. This legislation also takes steps to improve the quality of kidney care by creating a 3-year Continuous Quality Improvement Initiative within the Medicare ESRD Program.

I urge my colleagues to join me in supporting this important legislation, which also has the support of all sectors of the kidney care community. We should maintain our commitment to Americans with kidney failure by improving the quality of care for these patients and help slow the occurrence of chronic kidney disease and kidney failure.

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