NxStage North America president Joe Turk took a firm stand against what he perceives as a lack of support for at-home hemodialysis treatment for Medicare patients with kidney failure, despite a growing consensus among private insurers that the procedure is "medically necessary" for some patients.
In a letter glibly titled "Really?", Turk outlined his disappointment in the policy as proposed, offered a few quick fixes and urged stakeholders to submit suggestions on the rule during the open comment period – before the proposal becomes policy.
CMS early last month issued an updated rule for reimbursement of home hemodialysis treatment that wasn’t much of an update at all. CMS maintained the reimbursement status quo, dashing NxStage Medical’s hopes of a more favorable physician payment environment – as well as some investors’ hopes of a near-term upside for NxStage Medical.
Turk released a statement, published on the NxStage Medical site yesterday, chiding CMS for issuing rules that "again miss a clear opportunity to address home hemodialysis access for Medicare patients," he wrote.
The CMS rule maintained reimbursement rates for at-home hemodialysis, which was already 20% lower than offered for in-clinic dialysis.
"It is disappointing to us that the rules would be proposed this way, particularly given the overwhelming clinical data in support of the therapy, the recent movement by private insurers, and the growing recognition of Medicare payment impact on home hemodialysis access," Turk wrote. "The Medicare payment system has encouraged the current practice where over 9 of 10 patients are going into the center for their dialysis, which is diametrically opposed to what physicians and nurses would choose for themselves."
It’s also contrary to moves being made by private insurers, Turk noted.
Last month health insurance and technology giant Aetna modified its policy on NxStage’s System One home hemo system, dubbing the device "medically necessary" rather than "experimental," a move that some suggested may body well for future Medicare decisions.
Fellow insurer UnitedHealthcare also updated its home hemodialysis guidelines, calling the procedure "medically necessary as an alternative to facility-based hemodialysis" in patients who are healthy and stable enough to undergo treatment at home.
"Medicare can respond by making two very simple fixes that could materially impact patient access to home hemodialysis – making the training payment consistent and appropriate given the resource requirements and clarifying ongoing coverage, including those for appropriate more frequent sessions as UnitedHealthcare, Aetna, and others have now done on the private insurance side," Turk wrote. "This is what Medicare should have done. It’s the only way to send the right message to patients and providers."
Turk urged other stakeholders to send comments and suggestions to CMS during the open comment period on the proposed rule, which closes September 4.
NXTM shares shot up 4.3% today, trading at $15.96 as of about 3:15 p.m. That doesn’t quite make up for the 10% slide since CMS issued the rule proposal on July 3.
"We think that Medicare is again missing a perfect chance to take the lead to improve access to this life-changing therapy," Turk wrote. "Doing nothing would be a real injustice to patients, and cannot be in the best interest of the public."
"We will comment and we hope that you, your friends, colleagues and family will as well," he concluded. "Together we can do something about this."