The American Kidney Fund said Wednesday it is instituting new "safeguards" to protect patients with kidney disease from being steered unnecessarily into commercial health insurance plans.
The Rockville, Md.-based nonprofit organization outlined a new series of measures that would protect patients' "autonomy and informed choice" when they seek help from the fund to pay their health insurance premiums.
A St. Louis Post-Dispatch investigation over the weekend uncovered how one of the nation's largest dialysis providers, Denver-based DaVita HealthCare Partners Inc., targeted some patients in a campaign to get them to buy insurance they didn't necessarily need. As part of that effort, DaVita employees told patients that the American Kidney Fund would pay their insurance premiums.
Internal company emails, obtained by the Post-Dispatch, described how DaVita encouraged low-income patients with end-stage renal disease to enroll in commercial plans when they were already covered by Medicaid. The internal emails span several months during last year's open enrollment period.
Allegations of so-called "steering" by providers already had become a matter of concern with federal regulators. The Centers for Medicare and Medicaid Services issued a request for comment earlier this summer to obtain more information on how patients were targeted.
Insurance companies have also complained to federal regulators after seeing large spikes in payments to dialysis centers. Government payors _ Medicare and Medicaid _ pay significantly less for the dialysis treatment than commercial insurers, creating an incentive for the dialysis company to enroll patients in commercial plans, which were usually out of reach financially for the Medicaid beneficiaries DaVita targeted.
"We adamantly oppose any provider efforts to improperly steer patients to private insurance plans, and we equally oppose insurer efforts to steer kidney patients into Medicare or Medicaid plans that may not adequately meet their needs," LaVarne A. Burton, American Kidney Fund president and CEO, said in a statement Wednesday.
Starting in 2017, the fund's new measures will include requiring patients to explain why an individual commercial plan is a better option for them than Medicare or Medicaid.
The American Kidney Fund will require referring dialysis providers to sign a code of conduct, which stipulates that providers need to keep the "best interests of the patients in mind" when referring patients to the fund for assistance.
The code also requires providers to give patients comprehensive, accurate and impartial information about their coverage options.
That information will have to include "financial and coverage-related" implications tied to a particular choice, according to the American Kidney Fund's statement.
The American Kidney Fund will develop its own new education materials to provide patients with objective information about insurance options.
A patient bill of rights will be provided to patients when they begin receiving financial help for monthly premiums from the fund. The bill of rights will explain the patients' freedom to choose coverage and providers and the freedom to make changes. It will explain patients can register online to follow their own American Kidney Fund grant status and report any concerns about the program and if their rights under the program have been violated.
"It is encouraging to see the American Kidney Fund engage on the issue of steering," said Emily Bremer, a Clayton, Mo.-based insurance broker. "The question now becomes, how well do patients truly understand their coverage options whether it be Medicaid, Medicare or an insurance policy, and will there still be opportunity for them to be misled?"
In 2015, the American Kidney Fund provided about $255 million worth of patient assistance to 93,000 kidney failure patients, according to its most recent filing with the Internal Revenue Service.
In regulatory filings, DaVita has said it contributes to the American Kidney Fund, but doesn't specify how much. The fund, in its filings with the Internal Revenue Service, does not list its contributors.
The fund currently assists a total of 2,038 patients in Missouri, which includes 41 in exchange plans, Burton told the Post-Dispatch.
