Our Health Care Practice: Something Good for your Heart

The health care practice at BKSH & Associates is considered a cornerstone of our firm. We are proud to be able to provide health care representation to a wide range of organizations, several of which have been with the firm for over 10 years.  Our clients in this arena include teaching hospitals, trade associations, pharmaceutical companies and health care providers.  The health care team also works with other firm clients whenever needed, consistent with our team approach to client service, such as the Governor of Puerto Rico and Santa Clara County, to address their health-related concerns.  

Jerry Klepner and Andie King lead BKSH’s health care practice.  Jerry Klepner is a specialist in health care, human services and labor relations issues and served as Assistant Secretary for Legislation at the Department of Health and Human Services under Secretary Donna Shalala.  Andie King served as Domestic Policy Advisor to former Minority Leader Dick Gephardt (D-MO) for 18 years and currently advises health care clients on legislative and regulatory matters.

BKSH’s health care professionals keep clients abreast of Washington events that affect their interests, including legislation moving through Congress and changing agency rules and regulations. They work daily with a variety of clients and stakeholders to create long term legislative agendas and to create and implement strategic plans. The team has regularly helped clients secure meetings and site visits with Senators and Representatives, as well as gain federal funding for health-related projects and secure Medicare reimbursement for a variety of health care providers.

In addition to these services, the team regularly contributes articles to client-related periodicals including a monthly nephrology trade publication. The most recent article, titled “Future of the Medicare Package Unclear,” is below.   

FUTURE OF THE MEDICARE PACKAGE UNCLEAR

By Andie King, Jerry Klepner and Briana Nord, BKSH & Associates

For those who like suspense, intrigue and uncertainty, the final months of the first session of the 110^th Congress can only be described as riveting. For those who prefer an orderly process and foreseeable outcomes, the congressional activities of November and December were maddening.

Starting in November 2007, the Senate Finance Committee began meetings of the members in efforts to reach agreement on a Medicare package that would include changes in the current end stage renal disease (ESRD) program. These discussions lasted until the Thanksgiving recess and then resumed when Congress returned in early December. With no agreement in sight, Finance Committee Chairman Max Baucus (D-MT) announced on December 6, 2007 that he was terminating the process of trying to reach a Committee agreement and that he would begin direct negotiations with the House on what he assumed was the Committee position.

Based on numerous meetings with Senators and staff, the kidney care community believed significant progress was being made as the Senate Finance Committee members discussed the ESRD program with the House. Led by Senator Kent Conrad (D-ND), a group of Finance Committee members were insisting on improvements in the provisions that passed the House last August. It appeared likely that the Finance Committee package of Medicare reforms would be more equitable to dialysis providers and contain the positive provisions concerning chronic kidney disease education, demonstration projects, technician certification, and other sections in the House-passed bill. The Finance package was believed to have contained a bundling provision but with a better reimbursement system. The House-approved bundling provision directed the Centers for Medicare and Medicaid Services (CMS) to create a bundled payment system for dialysis services at a payment rate of 96 percent of total estimated payments for all ESRD services as if there were no bundled system.

On December 7, 2007, House and Senate staff met to discuss an overall Medicare package that would have as its centerpiece a provision to stop the scheduled 10 percent cut in Medicare physician reimbursement that will take place on January 1, 2008 unless Congress acts to prevent its implementation. Meetings continued over the weekend and on Monday, December 10, it appeared that an agreement among the staff was within reach. But the next morning, the process came to a screeching halt. An agreement could not be reached among the Senators and Representatives.

A vote on the Medicare package was to take place later in the day. However, House leaders announced that the Medicare vote would be delayed for two days until a new House package would be added to a bill providing relief from the Alternative Minimum Tax (AMT). But when the morning of December 12, 2007 arrived, the Medicare package was no longer going to be part of the AMT bill. It then appeared that the House would consider its own version of Medicare reform as a free-standing bill and the measure would be brought to the House floor for a vote on Wednesday, December 13, 2007. Then, Wednesday night, the House Leadership announced that a vote on the Medicare package would take place the week of December 17, 2007, the last week that Congress was in session before recessing for the Holidays and for the end of the first session. On December 13, 2007, Speaker Nancy Pelosi (D-CA) said, “The House will not be originating a Medicare bill.” This left it up the Senate to go first.

Where are we now in the legislative process? The ESRD provisions in the House-passed Children’s Health and Medicare Protection Act (CHAMP) were not included in the Medicare package that was ultimately approved by the Senate and House and signed into law by the President. Nor did the legislation include an update in the composite rate for this year. What Congress did was delay the scheduled 10 percent reduction in physician reimbursement until June 30, 2008 and extend a number of other primarily rural-based provisions for the same period of time. It also reauthorized through March 2009 and provided additional funding for the Children’s Health Insurance Program.

By only delaying for six months the reduction in physician reimbursement, Congress virtually guaranteed that another Medicare bill will be considered during the spring of this year. Democratic leaders in the House are taking the position that the Medicare package that was passed last summer as part of the CHAMP Act is still pending, leaving it up to the Senate to produce a Medicare bill. The bottom line is that the current ESRD program will again be debated in Congress this year and that major reform may only be a few months away.

“Future of the Medicare Package Unclear” is published in Dialysis and Transplantation News, Volume 37, Issue 2, Wiley InterScience, February 2008.