Update (2:39 p.m.): Kidney Care Partners released an official statement.

The umbrella group Kidney Care Partners (KCP), an advocacy and lobbying organization for dialysis providers, patient groups, drug companies and others, drew up a plan to respond to our investigation into dialysis care. We obtained a leaked copy that you can read below. (We have tried to reach the group's communications counsel for comment but have not yet received a response.)

Our Planned Response:

The Message

The attached general talking points have been assembled based on what we assume will be in the ProPublica story on Tuesday. Our talking points focus on communicating four key messages:

• Quality: Quality is very high and on an upward trajectory in the U.S., and the kidney care community is committed to continuing those positive quality trends.
• Patient Education and Early Detection: The kidney community has been a leader in its efforts to educate patients about disease symptoms and effective disease management.
• Care in the U.S. vs. Other Countries: In a worldwide view of kidney care, the U.S. is second in kidney transplantation rates per million population. While excelling in this key area, the U.S. continues to focus on improving in other areas.
• Payment Issues: The kidney care community has worked with Congress to improve and strengthen the integrity of the Medicare benefit to ensure patient access and sustained quality improvements. A key improvement has been the inclusion of a value-based purchasing program and an annual cost of living adjustment.

Points to support these basic messages are provided in the attached document. Because many of these points may be left out of the ProPublica story, we believe it is important for us to reinforce the facts, if asked to react to the content of these stories.

The Process

Schmidt Public Affairs has been in close contact with the reporter and has provided materials and information (as have numerous other KCP members) in an effort to round out the story and ensure that a fair and balanced perspective of the kidney community is reported. Despite our collective efforts, we do not anticipate a balanced presentation, and we therefore feel it’s essential to create the "machinery" necessary to orchestrate an aggressive and prompt community-wide response. Key steps in our plan include the following:

• Preparation:
• • Distribute story background and preliminary talking points on to all KCP members and lobbyists to ensure they are aware of the story and are prepared to respond to it, if necessary. We do not suggest that either members or lobbyists reach out to government officials or others in advance of the story’s release. (Patton Boggs will determine who among our allies should be contacted and assess content of article to set an action plan for outreach.) We do not want to call unnecessary attention to the story or give it “legs” in any way.
  • Distribute the story as soon as it is available online to all KCP members.
• Immediate Post-publication Activities:
• • Post a KCP response on the ProPublica website and the KCP website immediately upon release of the story. Our message will be brief and will mirror the attached talking points in an effort to put forward an immediate positive statement containing facts not likely highlighted in the story.
  • Provide KCP statement (and any KCP member statements) as well as talking points to legislative counsel for proactive or reactive use (defer to lobbyists.)
  • Trigger postings from all Operations Committee member organizations and other KCP Board members responding to the story, giving direction as to how to post responses, with key message points as guides. Because we want to rebut as many of the allegations contained in the story as possible, we ask that constituency groups within KCP take the lead in focusing their responses on specific issues:
  • • i. Physician groups and individual providers focusing on quality issues
    • ii. Patient and nursing groups focusing on patient education and payment issues
    • iii. All other members sending general responses consistent with KCP talking points
  • Prepare a more detailed response within 24 hours that is sent to the ProPublica editors and to Robin Fields. This detailed response will be posted to the KCP website as well. In preparing it, we will work with a small KCP subgroup of the Operations Committee.
  • Determine whether organized outreach to Capitol Hill is warranted and, if so, determine communication content and vehicle.
  • Track national, regional, policy/trade news outlets and social media to determine whether story will get traction through other media outlets.
• Longer Term Post-publication Activities:
• • Begin process again in preparation for second, third and future stories.

PRELIMINARY/DRAFT TALKING POINTS

The ATLANTIC /ProPublica Story On Dialysis

Message 1: Quality of patient care is high and has improved measurably in the United States, and the kidney care community is committed to continued quality improvement.

• Medicare’s end stage renal disease program is one of our nation’s greatest health care success stories, ensuring the delivery of life-saving care to nearly 400,000 patients with kidney failure every year, and doing so with unparalleled transparency and demonstrably high quality of care.
• Despite positive quality trends in many areas, the community recognizes the need to continually improve. One area the community and other stakeholders are working on is improving mortality for patients in the first year of dialysis.
• The kidney community has been deeply engaged in a variety of quality improvement initiatives. Activities have ranged from establishing the Kidney Care Quality Alliance to develop quality measures, which have been endorsed by the National Quality Forum, to launching a major initiative to reduce mortality in first-year dialysis patients by 20 percent by the end of 2012 (PEAK).
• Government data clearly show that quality improvement trends are on the rise and have been for more than a decade. In fact, since 2002, providers have sustained or improved quality in 9 of 11 quality measures tracked by CMS, such as:
• • Some measures that have improved include hemoglobin levels, Kt/v, phosphorous, and calcium.
  • Outcomes have improved in universally accepted clinical process measures, such as:
  • • Infectious disease is the second most common cause of death among ESRD patients.
    • Vaccinations of ESRD patients to avoid infectious disease have increased dramatically in recent years. According to 2009 USRDS data, vaccination rates increased 58 percent between 1996 and 2008.
• AV Fistula use increased 99 percent between 1998 and 2008. Fistulas are the safest way to get access to the bloodstream, with patients experiencing lower rates of mortality, infection and fewer hospitalizations. Fistulas are a primary area of emphasis for CMS and the kidney community for significantly improving outcomes, spearheaded by the Fistula First Breakthrough Initiative which has resulted in significant improvement.
• Facilities and providers report quality data routinely and will report even more quality data in the months ahead.

Message 2: The kidney community has been a leader in its efforts to educate patients about disease symptoms and effective disease management.

• The kidney community has been a leading advocate for private and public programs that address early detection, education, and disease management for those suffering from kidney disease and kidney failure.
• In 2007, Congress enacted into law provisions strongly supported by KCP that fund public and patient education initiatives to increase awareness about chronic kidney disease (CKD) and to help Stage IV CKD patients learn self-management skills that help prevent further disease progression control their CKD
• The Medicare Improvements for Patients and Providers Act (MIPPA) establishes coverage for 6 educational sessions for Medicare beneficiaries with Stage IV CKD, the precursor to kidney failure, and establishes pilot projects to:
• • Increase awareness regarding CKD, focusing on prevention
  • Increase screening for the disease, focusing on Medicare beneficiaries at-risk of CKD
  • Enhance surveillance systems to better assess the prevalence and incidence of CKD
• Different organizations within the kidney community offer a myriad of screening and educational programs.

Message 3: In a worldwide view of kidney care, the U.S. is second in kidney transplantation rates per million population. While excelling in this key area, the U.S. continues to focus on improving in other areas.

• The U.S. is a leader in kidney transplantation rates. In 2007, the U.S. reported transplant rates of 58.1 percent per million population.
• While excelling in the area of transplants, U.S. providers continue to focus on improving in the following areas: early detection of kidney disease, use of fistulas, and improved rates of survival. Factors that should be taken into consideration when making international comparisons include the following:
• More expanded health care coverage in other industrialized nations leads to early detection of kidney disease, more frequent access to medical professionals, which can include more preventative, interventional and specialty care.
• In the U.S., 40 percent of patients who are diagnosed with kidney failure have never visited a nephrologist prior to needing dialysis, and because of this fact, more patients come to dialysis with catheters.
• 82 percent of dialysis patients in the U.S. start dialysis using a catheter. While the use of fistulas is growing, more attention needs to focus on fistula insertion as a means of producing positive clinical outcomes.
• Until recently, the Medicare program has included disincentives for surgeons to insert fistulas. By increasing awareness through the “Fistula First” program and increasing payments for surgeons for the fistula procedure, the use of fistulas is also increasing.
• Patient demographics play a significant role in clinical outcomes. The typical dialysis patient in the U.S. has more medical and co-morbid conditions than patients in other countries. These conditions include heart disease, high blood pressure, obesity, and diabetes, complicated by poor diet and nutrition, than in many other industrialized nations.

Message 4: There is a direct link between quality and economic stability in health care. And for that reason, KCP has led efforts to improve and strengthen the Medicare benefit through the creation of a value-based purchasing program and an annual cost-of-living adjustment.

• Starting in 2012, Medicare will link payment to performance in kidney care. Dialysis providers who fail to meet government-established quality benchmarks will be penalized with a Medicare funding cut of up to 2 percent. Dialysis providers are the first of any health care sector to operate under a true value-based purchasing model.
• Dialysis providers have been improving quality outcomes (see Point 2 for details) despite very thin operating margins. According to the Medicare Payment Advisory Commission (MedPAC), dialysis provider margins in 2008 were 2.5 percent, much lower than most other sectors of healthcare.
• According to MedPAC, 25 percent of dialysis providers have margins at or below negative(-) 5.5 percent.
• After decades of kidney community advocacy, Congress mandated that Medicare provide an annual payment adjustment to reflect cost increases associated with delivering quality care, which is now going into effect. Dialysis providers had been the only health care providers who did not receive such an update