WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Monday, July 2, that would update Medicare policies and payment rates for End-Stage Renal Disease (ESRD) facilities paid under the ESRD Prospective Payment System (PPS) for calendar year (CY) 2013.

The proposed rule would also strengthen incentives for improved quality of care and better outcomes for patients through improvements to the ESRD Quality Incentive Program (QIP). Performance scores on the QIP measures during a proposed CY 2013 performance period would affect payments to dialysis facilities in CY 2015.

In addition to other updates, payment rates for outpatient maintenance dialysis treatments are anticipated to increase by 2.5 percent in CY 2013. This reflects the ESRD bundled market basket increase of 3.2 percent reduced by a productivity adjustment of 0.7 percent, as required by statute. CMS estimates that Medicare payments to the 5,633 ESRD facilities in CY 2013 will total $8.7 billion. When all policy changes are considered together, payments to ESRD facilities are expected to increase by 3.1 percent in 2013.

“As we enter the third year of our four year transition to the new fully bundled payment system for certain dialysis facilities, 90 percent of facilities are voluntarily receiving payments under the new system,” said Jonathan Blum, CMS deputy administrator and director of the agency’s Center for Medicare. “We believe that the policies and rate changes proposed today will continue to help ensure that beneficiaries diagnosed with ESRD continue to get the care they need.”

The proposed rule would continue to focus on clinical measures and expand the scope of the reporting measures included in the ESRD QIP to encompass a broader range of patient populations who receive dialysis care and to address concerns about the quality of life experienced by patients on dialysis. Specifically, CMS is proposing that ESRD facilities collect data for four reporting measures to capture information about how well each facility:

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MUNICH & LUND, Sweden--(BUSINESS WIRE)--Annual growth of more than 10 per cent – focus on improving quality of life for renal patients

“Also the name Diaverum was chosen deliberately: ‘dia’ represents our core business dialysis, while ‘verum’ is Latin for truth. Hence, the name of our company symbolises the honesty, transparency and reliability that Diaverum is known for today.”

Today, Diaverum is celebrating its 5th anniversary as an independent renal care provider. After the divestiture of the Gambro Healthcare Division in 2007 and the founding of Diaverum, the ‘new’ renal care provider has entered several new markets including Germany, Chile, Romania and Saudi Arabia. During this period the number of patients has increased by more than 50 per cent. Diaverum currently operates 252 clinics in 17 countries in Europe, Latin America, Australia and the Middle East.

On the occasion of the anniversary, Dag Andersson, CEO and President of Diaverum, said: “I am very proud of what we have achieved over the last five years. We have been able to leverage the dialysis experience and knowledge from 15 years as part of Gambro, add efficiencies regarding operating dialysis clinics and create a company culture that truly puts the patient in the centre – while at the same time reporting impressive growth figures”. Since June 2007, Diaverum opened more than 80 new clinics. Currently Diaverum cares for more than 20,000 patients worldwide conducting three million dialysis treatments per year.

Young player with a long history

The renal care history of Diaverum started with the founding of the Gambro Healthcare Division in 1991 and the first dialysis clinic opened in Lund, Sweden. Shortly after the divestiture of this division on 2 July 2007, the name Diaverum was adopted and launched globally. The key shareholder is Bridgepoint, a private healthcare investor.

Revitalising renal patients

“When launching Diaverum as independent provider we wanted to form a very unique appearance, reflecting our brand promise to ‘revitalise our patients, both physically and emotionally’. We chose a water colour style designed by a Swedish artist with light, vivid and revitalising expressions, which has proven to stand out in the rather ‘technical’ healthcare market”, explained Christina Sterner, Chief Communication Officer at Diaverum. “Also the name Diaverum was chosen deliberately: ‘dia’ represents our core business dialysis, while ‘verum’ is Latin for truth. Hence, the name of our company symbolises the honesty, transparency and reliability that Diaverum is known for today.”

Committed to quality

The main focus for Diaverum is to provide the highest level of quality care and run the clinics in a very safe and efficient way. Thus, significant efforts are devoted to integrating each new clinic through a 100-day and 1-year integration plan. Diaverum is fostering a culture of quality where all efforts are focussed on ultimately benefitting renal patients. Key elements are the awarded medical and scientific research organisation, the accredited training programmes, clinic audits and employee engagement activities.

Expanding the service offering

The prevalence of two of the most important risk factors for chronic kidney diseases, diabetes and hypertension is increasing at a fast pace. By 2025, it is estimated that 380 million people will suffer from diabetes and 1.6 billion people will have high blood pressure. The number of patients with end stage renal disease (ESRD) is estimated to increase to 4 million by 2025, almost doubling compared to 2010. For ESRD-patients, the only alternative treatments are lifelong dialysis or kidney transplantation. These figures will present significant challenges to health systems.

“We are actively taking measures to seek better ways for early diagnosis and treatment, also from a socioeconomic perspective. We are expanding the services offered, including more preventive and early stage renal care. In some countries, we are already operating nephrology wards and our aim is to actively engage with the wider public and to advise them on how to prevent kidney diseases from the very start”, said Dag Andersson, providing an insight into the near future. “Going forward, we will continue to explore further geographic markets, focus on organic growth and expand our offering. We want to improve the quality of life for an increasing number of renal patients – worldwide.”

To celebrate the 5th anniversary, Diaverum is - amongst other things - having a lottery both on the internal and external website. Visitors on corp.diaverum.com (http://www.corp.diaverum.com/) can win one of five ipods in the typical Diaverum orange.

About Diaverum

At Diaverum, our mission is to improve the quality of life for renal patients by revitalising them both physically and emotionally. Being one of the world’s leading renal care providers, Diaverum offers a holistic approach, from preventive and early stage renal care to all renal replacement therapies. As a product independent provider — the largest in Europe — we are able to focus solely on caring for the individual needs of our patients. Our experience in renal care dates back 20 years, when the first dialysis clinic was established, previously under our former name Gambro Healthcare. Today, 6,900 employees care for more than 20,000 patients in 17 countries in Europe, Latin America, Middle East and Australia. The corporate office of Diaverum is located in Munich, Germany, the head office is in Lund, Sweden. For more information visit www.diaverum.com.

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NEW YORK—NPS Pharmaceuticals Inc. will receive a one-time $25 million payment this month in exchange for its rights to receive royalties earned after 2018 for sales of its Sensipar drug under an amended license agreement with Amgen Inc reported NASDAQ.

Sensipar, marketed as Mimpara in Europe, treats secondary hyperparathyroidism in chronic kidney disease patients on dialysis. In 1996 NPS licensed world-wide rights to Amgen to develop and commercialize the drug, and the drug received FDA approval in March 2004.

NPS said funds from the agreement are expected to support the launches of both Gattex, a treatment for short bowel syndrome, and Natpara, which is intended to be used for adult hypoparathyroidism, in addition to aiding its transition into a self-sustaining commercial-stage business.

The deal is expected to accelerate cash flow with at least $75 million of incremental cash expected through 2013.

The amendment also extends the royalty-advance-repayment period, limiting the offset of the royalty advance that the biopharmaceutical company received from Amgen in August 2011 to $8 million a quarter.

After repayment of the advance and a 9 percent anum discount factor on the balance of $92 million, Amgen will resume paying NPS all royalties earned through 2018.

"This innovative transaction underscores our commitment to accessing capital at the lowest possible cost and in a manner that is in the best interests of our shareholders," said Luke M. Beshar, NPS's chief financial officer.

Shares of NPS were inactive in premarket trade at $8.61, while shares of Amgen slipped 0.2 percent to $72.75. NPS is up 31 percent so far this year, while Amgen is up 14 percent.

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EDITORIAL

Predictions & Public Policy

In the early 1970s, lawmakers passed legislation that mandated Medicare to assume most of the financial burden for caring for eligible patients with late-stage kidney disease who required dialysis, regardless of their age. Then dialysis equipment improved, positively impacting the mortality and morbidity outlook for these patients. The U.S. Renal Data System, which collects, analyzes and reports on ESRD incidence for the Centers for Medicare & Medicaid Services (CMS) and others, estimates in its 2011 Atlas that the ESRD patient population totaled 571,414 in 2009 at a cost of $29 billion for Medicare.  

ESRD is a debilitating condition and Medicare should be commended for shouldering the financial burden for this vulnerable patient population. But the nephrologist’s tale about the unintended consequences of public policy decisions came to mind as I gathered background information for our cover story on physician compensation. To equitably determine compensation for physicians serving Medicare patients, the federal government sought an objective methodology for determining the value of a service and appropriate fees for calculating compensation.

Thus, the relative value unit and the Relative Value Update Committee (RUC) were born. It was public policy decisions that created the fee-for-service model, which—as our article details—rewards volume and partly has contributed to overutilization. The RUC, an expert advisory body of physicians that is not funded by CMS, works within the restrictions of its defined service to CMS. Although members must remain mute in discussions about their respective specialties, some critics argue that physicians have a vested interest in decisions that affect physician pay. But many critics also say physicians must be involved, otherwise decisions that affect patient care are made in a vacuum.

There are no easy answers, especially when resources are limited and needs are immense. I doubt policymakers anticipated that the fee-for-service model would strain federal coffers. Do you foresee drawbacks in the alternatives? I would love to hear.

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