QUESTIONS AND A WRITTEN RESPONSE QUESTIONS: 1) The August 21, 2007 contract between Kidney Specialists of Southern Nevada and University Medical Center, on page 4 of the contract notes that the duties under the agreement which ran from August 2007 until July 2010 included: "Provide Transplant Nephrologist to offer training and support of Hospital's Kidney Transplant Program. Support of the Transplant Program requires the provision of two four (4) hour clinics per week within the Transplant Center. The Transplant Nephrologist will provide medical examination and clearance for all prospective transplant patients." This role, through late 2008, was played by Dr. Marvin Bernstein, one of the partners of your husband, who served in the capacity as primary transplant nephrologist. In retrospect, do you feel that it was appropriate for you to get involved in this effort to save the UMC program from decertification given that your husband's practice had a contract that specifically related to this unit at the University Medical Center, a contract that would be renewed in December 2010 with a 25 percent increase in fees? I realize that other members of the Nevada delegation were very involved in objecting to the closure. But Health and Human Services provided me with only one formal letter--and it was sent from your office (with cosignatures from two other members) 2) DaVita is one of your single biggest campaign contributors. The company has been particularly generous in 2011 as you run for the Senate. At the same time, DaVita is a joint venture partner of your husband in his dialysis centers. Do you have a conflict of interest in serving as a champion for DaVita-- the Kidney Care Council, which DaVita is a member specifically thanked you in April 2011 for your role in opposing the transition adjuster for the payment bundle-- given that the company is a business partner of your husband? 3) You husband served as chairman of the Renal Physicians Association Political Action Committee and is still listed as a member of the RPA Pac governing board. Even if he recently stepped down from such a post, it is clear he has had a leadership position at least on and off with the RPA PAC since 2006. At the same time, your husband is the single biggest giver to the RPA PAC. And you are the single biggest recipient of donations from the RPA PAC. In February 2008, the RPA PAC, DaVita and other kidney care players donated money to your campaign, with several of those donations coming in on the same day you sent a letter to Rep. Pete Stark expressing concern about the proposal to move to a bundling system. Is it proper for you to have taken money from these players so closely in alignment with the sending of this letter, particularly given your husband's involvement in the PAC? 4) House ethics rules prohibit a spouse from lobbying his wife or husband, who happens to be a member of Congress. "Special caution must be exercised when the spouse of a Member or staff person, or any other immediate family member, is a lobbyist. At a minimum, such an official should not permit the spouse to lobby either him- or herself or any of his or her subordinates." Your husband has never formally registered as a lobbyist. Do you believe you have honored both the letter and the spirit of this ethics rule? 5) In October 2010, Kidney Specialists of Southern Nevada celebrated the opening of its newest dialysis center, the large new facility in Pahrump. You attended the event, even presenting the KSOS practice with a certificate of congressional recognition to mark the grand opening. Was this appropriate, given that your husband is the president of the practice to give this certificate? RESPONSE: Statement from Congresswoman Shelley Berkley: I won't stop fighting to give Nevadans access to affordable healthcare just because my husband is a doctor, just as I won't stop standing up for veterans because my father served in World War II. I've worked closely with other members of our delegation over many years to make care available to veterans and to patients suffering from cancer, diabetes, autism, heart disease, kidney disease, and other illnesses, while trying to prevent bureaucrats in health insurance companies and in government from adding to the heavy burdens patients are already bearing. Statements from Jessica Mackler, Campaign Manager at Berkley for Senate as they relate to the topics you have brought up: UMC Kidney Transplant Center Intervention As Brian Brannman, CEO of UMC, told The New York Times, it was at the request of UMC and her Republican colleague that Congresswoman Berkley signed onto a letter with the Nevada delegation to save the state's only kidney transplant program. If the program had been revoked, sick patients would have had to travel to Arizona or California for care. Reps. Porter, Heller and Berkley worked with the Medicare program and UMC to make sure that Nevada patients had the access to care they deserve. At the time, the consumer watchdog group Citizens for Responsibility and Ethics in Washington (CREW), stated that Congresswoman Berkley's work to ensure her constituents had access to kidney care was not a conflict of interest. Kidney Specialists of Southern Nevada (KSOSN) Contract with UMC After the previous transplant nephrologist passed away, Dr. Marvin Bernstein agreed to temporarily lead the program, and work with the United Network for Organ Sharing (UNOS) and UMC to ensure quality care. During the time period that Dr. Bernstein led the program, the Kidney Specialists of Southern Nevada and UMC worked aggressively to recruit another transplant nephrologist to take over the program. As Brian Brannman, CEO of UMC, has noted, the problems associated with the program at UMC were due to a lack of resources provided by the hospital for the kidney treatment program and not the untimely death of Dr. Snyder. Lobbying/Ethics Rule Dr. Lehrner is a doctor, not a lobbyist. Congresswoman Berkley has honored both the spirit and the letter of the ethics law, which was never intended to suggest that spouses could not talk with each other about their opinions on issues. Congresswoman Berkley's sole motivation has been to make sure that Nevadans have access to quality care. She strongly opposed moving to a bundled payment system that includes oralonly drugs because affordable access to care is her top priority and the bundle system will require a 20 percent Medicare copayment for many Nevadans and could close small dialysis centers in the state by imposing overwhelming new regulations. DaVita/Kidney Care Partners This implication is ridiculous and has no basis in fact or evidence. Congresswoman Berkley has been a champion for the more than 4,000 Nevadans diagnosed with renal disease each year. Congresswoman Berkley believes that sick patients in Nevada, where the doctor to patient ratio is ranked near last in the country, deserve the best care possible and that is why she has fought to provide access to the highest quality care for kidney patients, as well as patients with diabetes, osteoporosis and cancer. She strongly opposed moving to a bundled payment system that includes oral-only drugs because affordable access to care is her top priority and the bundle system will require a 20 percent Medicare copayment for many Nevadans and could close small dialysis centers in the state by imposing overwhelming new regulations. BACKGROUND: Of the 39 dialysis centers in Nevada, less than half are operated by DaVita. DaVita is just one of 13 entities that make up the Kidney Care Partners organization. Berkley work on kidney care issues is motivated by her desire to improve care for sick patients across Nevada and the country. Congressional Certificate Congresswoman Berkley gives out more than 1,000 certificates like this one each year on a wide range of issues from birthdays to honoring school groups. There are many people doing work in Pahrump at the treatment center and they deserve recognition. The expanded dialysis center means that the patients who get care at the Pahrump center no longer have to travel nearly 120 miles round-trip to get care. That's a great service to the community. This is just one part of Berkley's long record of championing access to care for under-served populations. Campaign Contributions These events have nothing to do with one another. Congresswoman Berkley does not apologize for being a champion for the health of Nevada residents, including the more than 4,000 Nevadans diagnosed with renal failure in 2008 alone. Congresswoman Berkley is proud to be a champion for sick patients who deserve leaders in Congress that stand up for them and fight for them to have the best care possible. That is what she has done both for kidney patients those with diabetes, osteoporosis and cancer. AN ADDITIONAL STATEMENT: In addition to responding to certain written questions, Ms. Berkley's office prepared its own statement detailing her record on kidney care. Facts on Berkley Record on Kidney Care UMC Kidney Transplant Center Intervention As Brian Brannman, CEO of UMC, told The New York Times, it was at the request of UMC and her Republican colleague that Congresswoman Berkley joined with the rest of the Nevada delegation to save the state's only kidney transplant program. If the program had been revoked, sick patients would have had to travel to Arizona or California for care. Reps. Porter, Heller and Berkley worked with the Medicare program and UMC to make sure that Nevada patients had the access to care they deserve. At the time, the consumer watchdog group Citizens for Responsibility and Ethics in Washington (CREW), stated that Congresswoman Berkley's work to ensure her constituents had access to kidney care was not a conflict of interest. The Facts PORTER AND HELLER SIGNED LETTER TO CMS OFFICIALS ABOUT UMC's KIDNEY TRANSPLANT PROGRAM Rep. Jon Porter Was The First Member Of The Nevada Delegation To Meet With CMS Officials About UMC's Kidney Transplant Program. According to the Review-Journal, "Nevada's only kidney transplant program might have a lifeline. Rep. Jon Porter R-Nev...said Wednesday he has had productive conversations twice in two days with Centers for Medicare and Medicaid Services, the agency that informed University Medical Center that certification for its transplant center is being revoked effective Dec. 3. Porter said in one of his conversations with CMS, he received assurance that the investigation of UMC's transplant program would be re-examined. 'The acting director has committed to me that CMS will review the whole investigation to ensure it was handled appropriately,' Porter said. 'I have made it clear to CMS that this is a critical program for Nevadans' ... Porter met with Kerry Weems, CMS' acting administrator, on Tuesday in Las Vegas. He spoke with CMS officials again Wednesday while back in Washington. David Cherry, a spokesman for Berkley, said the congresswoman is scheduled to meet with CMS officials sometime today. It was unclear whether Heller would be speaking with CMS." [Review-Journal, 10/30/08] Rep. Porter's Office Initiated the Letter. Staff from Rep. Porter e-mailed the offices of Reps. Berkley and Heller to suggest a joint letter after urging from UMC. [E-Mail from Rep. Porter's office to Rep. Berkley's office, 10/23/08] Rep. Dean Heller Signed Onto Letter With Rep. Jon Porter And Rep. Shelley Berkley "Expressing Their 'Strong Disagreement' With The Agency's Decision." In October 2008, the Las Vegas Review-Journal wrote, "On Friday, Reps. Shelley Berkley, Jon Porter and Dean Heller sent a letter to CMS' acting administrator, Kerry Weems, expressing their 'strong disagreement' with the agency's decision. In their letter, they reference what they believe is the remaining unresolved deficiency -- the patient survival outcomes. The May 2005 suicide caused UMC to not meet compliance standards for two overlapping reporting periods -- July 1, 2004 to Dec. 31, 2007 and Jan. 1 2005 to June 30, 2007. 'This suicide of an otherwise successful transplant patient is lamentable, but beyond the control of UMC,' the letter states." [Las Vegas Review-Journal, 10/25/08] CREW: NO CONFLICT OF INTEREST FOR BERKLEY BECAUSE DR. LARRY LEHRNER "DOES NOT HAVE A DIRECT FINANCIAL TIE TO MEDICARE." CREW: No Conflict Of Interest For Berkley Because Dr. Larry Lehrner "Does Not Have A Direct Financial Tie To Medicare." In November 2008, the Las Vegas Sun wrote, "The political appeals for leniency included a letter and personal conversations with the head of Medicare by Rep. Shelly Berkley, D-Las Vegas, and Republican Reps. Jon Porter and Dean Heller. Berkley's husband, Dr. Larry Lehrner, is a partner at Kidney Specialists of Southern Nevada, which has a $588,200 annual contract to provide nephrology services at UMC, which includes the kidney transplant program. UMC officials said Lehrner handles the business aspects of the contract, not the medical services. Officials from Citizens for Responsibility and Ethics in Washington said they do not consider Berkley's advocacy for UMC a conflict of interest because Lehrner does not have a direct financial tie to Medicare." [Las Vegas Sun, 11/4/08] (Emphasis added) PATIENTS WOULD HAVE HAD TO GO TO SCOTTSDALE OR LOS ANGELES FOR TREATMENT IF UMC HAD LOST THE KIDNEY TRANSPLANT PROGRAM Clark County Patients Would Have Had To Go To Scottsdale Or Los Angeles For Treatment If UMC Had Lost The Kidney Transplant Program. According to the Review-Journal, "Four months after becoming the state's only kidney transplant program, University Medical Center has been stripped of that privilege, leaving in doubt where more than 200 Nevadans awaiting kidney transplants might go for their procedures. UMC was notified in a Thursday letter by Centers for Medicare and Medicaid Services, or CMS, that its certification for the transplant center will be revoked effective Dec. 3. That means the hospital will not receive any payments for transplant services on or after that date, effectively closing the program ... Patients in need of kidney transplants may now have to travel to out-of-state facilities such as the Mayo Clinic in Scottsdale, Ariz., or UCLA, officials say. " [Review-Journal, 10/25/08] o Review-Journal: "Additionally, since the center is the only one of its kind in Nevada, some 200 people awaiting kidneys in Nevada would have to travel at least 300 miles out of the state for the procedure." [Review-Journal, 10/31/08] Cancer Institute Co-Founder: "It's Just Not Right For People To Have To Get On A Plane Or Drive To California Or Arizona ... When They Get Sick." In March 2002, Nevada Cancer Institute CoFounder Jim Murren told the Sun, "There's universal agreement that it's just not right for people to have to get on a plane or drive to California or Arizona (for treatment) when they get sick ... There's certainly a big need for this here, because of our demographics." [Las Vegas Sun, 3/18/02] o 2008: 4,800 PATIENTS DIED WHILE WAITING FOR KIDNEY TRANSPLANT 2008: 4,800 Patients Died While Waiting For Kidney Transplant. According to CBS, "In 2008, of the 82,000 patients on the waiting list in the United States, 16,520 received kidney transplants whereas 4,800 died waiting for one." [CBS42.com, 7/28/11] Kidney Specialists of Southern Nevada (KSOSN) Contract with UMC After the previous transplant nephrologist passed away, Dr. Marvin Bernstein agreed to temporarily lead the program, and work with the United Network for Organ Sharing (UNOS) and UMC to ensure quality care. During the time period that Dr. Bernstein led the program, the Kidney Specialists of Southern Nevada and UMC worked aggressively to recruit another transplant nephrologist to take over the program. As Brian Brannman, CEO of UMC, has noted, the problems associated with the program at UMC were due to a lack of resources provided by the hospital for the kidney treatment program and not the untimely death of Dr. Snyder. Lobbying/Ethics Dr. Lehrner is a doctor, not a lobbyist. Congresswoman Berkley has honored both the spirit and the letter of the ethics law, which was never intended to suggest that spouses could not talk with each other about their opinions on issues. Congresswoman Berkley's sole motivation has been to make sure that Nevadans have access to quality care. She strongly opposed moving to a bundled payment system that includes oralonly drugs because affordable access to care is her top priority and the bundle system will require a 20 percent Medicare copayment for many Nevadans and could close small dialysis centers in the state by imposing overwhelming new regulations. The Facts "The New ESRD Payment Structure Will Require Patients To Pay A 20 Percent Co-Payment On The Entire Bundled ESRD Payment." According to the American Kidney Fund, "The new ESRD payment structure will require patients to pay a 20 percent co-payment on the entire bundled ESRD payment. The new bundled payment system will include services such as your dialysis treatments, dialysis labs and injectable medications received during treatment, like Epogen, iron, and vitamin D. Also included will be the oral form of iron and vitamin D, particularly for patients using home dialysis. Even if you do not use all of these services, you will still be responsible for sharing the costs." [American Kidney Fund, February 2011] DaVita/Kidney Care Partners This implication is ridiculous and has no basis in fact or evidence. Congresswoman Berkley has been a champion for the more than 4,000 Nevadans diagnosed with renal disease each year. Congresswoman Berkley believes that sick patients in Nevada, where the doctor to patient ratio is ranked near last in the country, deserve the best care possible and that is why she has fought to provide for kidney patients, as well as patients with diabetes, osteoporosis and cancer. She strongly opposed moving to a bundled payment system that includes oral-only drugs because affordable access to care is her top priority and the bundle system will require a 20 percent Medicare copayment for many Nevadans and could close small dialysis centers in the state by imposing overwhelming new regulations. BACKGROUND: Of the 39 dialysis centers in Nevada, less than half are operated by DaVita. DaVita is just one of 13 entities that make up the Kidney Care Partners organization. Berkley has worked on kidney care issues to improve care for sick patients across Nevada and the country. The Facts DAVITA OPERATES LESS THAN HALF OF THE 39 DIALYSIS CLINICS IN NEVADA AND IS ONE OF 32 MEMBERS OF KIDNEY CARE PARTNERS DaVita Operated 18 Of The 39 Dialysis Clinics In Nevada. According to Data.gov, DaVita operates 18 of the 39 dialysis clinics in the state of Nevada. [Data.gov, Dialysis Facility Compare, accessed 8/31/11] DaVita One Of 32 Members Of Kidney Care Partners. According to their web site, DaVita is one of 32 partners of Kidney Care Partners. [Kidney Care Partners web site, accessed 9/01/11] BERKLEY CO-SPONSORED AT LEAST 95 BILLS RELATED TO VARIOUS MEDICAL ISSUES AND DISEASES... Berkley Co-Sponsored At Least 95 Bills Related To Various Medical Issues And Diseases. Berkley sponsored or co-sponsored at least 95 bills related to a number of medical issues and diseases -from breast cancer to heart disease to kidney disease to inflammatory bowel disease. [Thomas.gov, accessed 8/19/11] ...SUCH AS DIABETES Berkley Co-Sponsored Diabetes Prevention Access and Care Act. In 2003, Berkley co-sponsored H.R.1916, Diabetes Prevention Access and Care Act. The bill was referred to the Subcommittee on Health. [HR 1916, Introduced 5/01/03] Berkley Co-Sponsored Preventing Diabetes in Medicare Act of 2007. In 2007, Berkley co-sponsored H.R.2922, Preventing Diabetes in Medicare Act of 2007. The bill was referred to the Subcommittee on Health. [HR 2922, Introduced 6/28/07] BERKLEY'S OWN DIAGNOSIS OF OSTEOPOROSIS LED TO ADVOCACY ON THE ISSUE Berkley Was Lead Sponsor Of Osteoporosis Education and Prevention Act. In 1999, Berkley was lead sponsor of H.R.2294: Osteoporosis Education and Prevention Act of 1999. The bill was referred to the Subcommittee on Early Childhood, Youth and Families. In 2004, Berkley was lead sponsor of H.R.3803: Osteoporosis Education and Prevention Act of 2004. The bill was referred to the Subcommittee on Select Education. In 2005, Berkley was lead sponsor of H.R.1081: Osteoporosis Education and Prevention Act of 2005. The bill was referred to the Subcommittee on Select Education. [Thomas.gov, accessed 8/19/11] Berkley Was Lead Sponsor Of Medicare Fracture Prevention and Osteoporosis Testing Act. In 2007, Berkley was lead sponsor of H.R.4206: Medicare Fracture Prevention and Osteoporosis Testing Act of 2007. The bill was referred to House subcommittee. Status: Referred to the Subcommittee on Health. In 2009, Berkley was lead sponsor of H.R.1894: Medicare Fracture Prevention and Osteoporosis Testing Act of 2009. The bill was referred to the Subcommittee on Health. [Thomas.gov, accessed 8/19/11] BERKLEY WAS LEAD SPONSOR ON CANCER BILLS Berkley Was Lead Sponsor Of Nevada Cancer Institute Expansion Act. In 2006, Berkley was lead sponsor of H.R.6383: Nevada Cancer Institute Expansion Act. The bill was referred to the Subcommittee on Forests and Forest Health. In 2007, Berkley was lead sponsor of H.R.1311: Nevada Cancer Institute Expansion Act. The bill was placed on Senate Legislative Calendar under General Orders. Calendar No. 812. In 2009, Berkley was lead sponsor of H.R.234: Nevada Cancer Institute Expansion Act. The bill was referred to the Subcommittee on National Parks, Forests and Public Lands. [Thomas.gov, accessed 8/19/11] Berkley Was Lead Sponsor Of Medicare Lung Cancer Early Detection Promotion Act. In 2009, Berkley was lead sponsor of H.R.2578: Medicare Lung Cancer Early Detection Promotion Act of 2009.The bill was referred to the Subcommittee on Health. In 2011, Berkley was lead sponsor of H.R.1172: Medicare Lung Cancer Early Detection Promotion Act of 2011. The bill was referred to the Subcommittee on Environment and the Economy. [Thomas.gov, accessed 8/19/11] ESRD PAYMENT STRUCTURE REQUIRES PATIENTS TO PAY 20 PERCENT CO-PAYMENT ON THE ENTIRE BUNDLED ESRD PAYMENT "The New ESRD Payment Structure Will Require Patients To Pay A 20 Percent Co-Payment On The Entire Bundled ESRD Payment." According to the American Kidney Fund, "The new ESRD payment structure will require patients to pay a 20 percent co-payment on the entire bundled ESRD payment. The new bundled payment system will include services such as your dialysis treatments, dialysis labs and injectable medications received during treatment, like Epogen, iron, and vitamin D. Also included will be the oral form of iron and vitamin D, particularly for patients using home dialysis. Even if you do not use all of these services, you will still be responsible for sharing the costs. However, not every patient will have the same costs. Factors such as age, body size, and whether a patient has other illnesses are variables which can change your payment. Depending on the patients' individual health condition, co-pay amounts may increase, decrease or stay the same." [American Kidney Fund, February 2011] SMALL DIALYSIS COMPANIES STRUGGLE TO MAINTAIN NECESSARY FINANCIAL VIABILITY TO CONTINUE TO SERVE PATIENTS NRAA: "As A (Small Or Medium Sized) Dialysis Facility We Are Struggling To Maintain The Necessary Financial Viability To Continue To Serve Our Patients..." According to a letter to Congress from the National Renal Administrators Association, "While a much smaller reduction in the per treatment reimbursement would be necessary in order to maintain budget neutrality, it would be significantly less than $6.75. As a (small or medium sized) dialysis facility we are struggling to maintain the necessary financial viability to continue to serve our patients, which is now being made even more difficult by CMS' reluctance to provide us with the reimbursement we deserve. Our Medicare margins are small or non-existent and (percent of overall revenue) is derived from serving Medicare beneficiaries. In a December 2010 analysis, the Medicare Payment Advisory Committee (MedPAC) found that the Medicare margin for dialysis facilities other than the two largest chains was 0.3 percent and that the margin for rural facilities was minus 1.4 percent. These numbers speak for themselves. We urge you to take whatever legislative action may be necessary to provide us with a fair reimbursement." [National Renal Administrators Association, accessed 8/31/11] o "The National Renal Administrators Association (NRAA), A Nonprofit Organization That Represents Small Dialysis Organizations Throughout The United States..." "The National Renal Administrators Association (NRAA), a nonprofit organization that represents small dialysis organizations throughout the United States, also told us that small dialysis organizations generally did not provide oralonly ESRD drugs or any other oral drugs in 2010." [United States Government Accountability Office, Report to Congressional Committees, "End-Stage Renal Disease: CMS Should Assess Adequacy of Payment When Certain Oral Drugs Are Included And Ensure Availability of Quality Monitoring Data, March 2011] NEVADA RANKED 48TH IN DOCTORS PER PATIENT AND "DEAD LAST" IN SPECIALTIES o Silver State Ranked No. 48 In Doctors Per Patient And "Dead Last" In Specialties. According to the Las Vegas Review Journal, "A 2009 study from the University of Nevada School of Medicine found that the Silver State ranked No. 48 in doctors per patient...'In specialties such as pediatric heart surgery, orthopedic surgery and spine surgery, the Silver State places 'dead last,' said Larry Matheis, executive director of the Nevada State Medical Association. So acute are the shortages that Nevada could double its number of pediatric-surgery specialists and still be last in the country for its share of doctors specializing in kids' care." [Las Vegas Review-Journal, 4/11/10] Nevada Has 190 Practicing Doctors Per 100,000 People. According to the Las Vegas Review Journal, "To understand how bad the state's shortages already are, consider that Nevada has 190 practicing doctors per 100,000 people. As of 2007, Nevada would have needed 262 practicing docs per 100,000 residents to post an average doctor-patient ratio, noted Dr. Annette Teijeiro, president of the Clark County Medical Society... The scarcity of physicians already means big wait times for nonemergency specialist care...It's gotten so bad that doctors and insurers increasingly send Nevadans out of state for specialty care because there aren't enough doctors here to handle the referrals." [Las Vegas Review-Journal, 4/11/10] o DOCTORS NO LONGER ACCEPTING MEDICARE BECAUSE OF LOW PAYMENT RATES Number Of Doctors Refusing New Medicare Patients Because Of Low Government Payment Rates Setting A New High. According to USA Today, "The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program. Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill. o The American Academy of Family Physicians says 13% of respondents didn't participate in Medicare last year, up from 8% in 2008 and 6% in 2004. The American Osteopathic Association says 15% of its members don't participate in Medicare and 19% don't accept new Medicare patients. If the cut is not reversed, it says, the numbers will double. o o The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%. The federal health insurance program for seniors paid doctors on average 78% of what private insurers paid in 2008." [USA Today, 6/21/10] Doctors No Longer Accepting Medicare, Either Because They Have Opted Out Of The Insurance System Or They Are Not Accepting New Patients With Medicare Coverage. According to the New York Times, "Some doctors -- often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists -- are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors' reasons: reimbursement rates are too low and paperwork too much of a hassle." [New York Times, 4/01/09] Medicare Payment Advisory Commission: 29 Percent Of The Medicare Beneficiaries It Surveyed Who Were Looking For A Primary Care Doctor Had A Problem Finding One To Treat Them. According to the New York Times, "In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state's doctors took new Medicare patients, only 38 percent of primary care doctors did." [New York Times, 4/01/09] Congressional Certificate Congresswoman Berkley gives out more than 1,000 certificates like this one each year on a wide range of issues from birthdays to honoring school groups. There are many people doing work in Pahrump at the treatment center and they deserve recognition. The expanded dialysis center means that the patients who get care at the Pahrump center no longer have to travel nearly 120 miles round-trip to get care. That's a great service to the community. This is just one part of Berkley's long record of championing access to care for underserved populations. The Facts Pahrump Dialysis Facility Was "The Beginning Of Attempting To Keep Treatment Local" And To "Prevent A Need For Patients To Travel 60 Miles Or So To Las Vegas To Get Their Care." In October 2001, when dedicating his new kidney dialysis center, Dr. Neville Pokroy was quoted by the Pahrump Valley Times as stating, "I tried to help establish a centralized medical campus for this community. So we tried to enhance the quality of patient care and hopefully this will continue to expand and prevent a need for patients to travel 60 miles or so to the city of Las Vegas to get their care. Obviously, we'll not be able to cover all the needs, but hopefully this is the beginning of attempting to keep treatment local. [Pahrump Valley Times, 10/13/10] Dr. Larry Lehrner Doesn't Even Practice At The Facility. According to Kidney Specialists of Southern Nevada's website, Dr. Larry Lehrner isn't listed as one of the three primary doctors that service the Pahrump location. [Kidney Specialists of Southern Nevada website, accessed 8/31/11] Campaign Contributions These events have nothing to do with one another. Congresswoman Berkley does not apologize for being a champion for the health of Nevada residents, including the more than 4,000 Nevadans diagnosed with renal failure in 2008 alone. Congresswoman Berkley is proud to be a champion for sick patients who deserve leaders in Congress that stand up for them and fight for them to have the best care possible. That is what she has done both for kidney patients those with diabetes, osteoporosis and cancer. The Facts THERE WERE 4,134 DIAGNOSES OF RENAL FAILURE IN NEVADA IN 2008 ALONE 2008: There Were 4,134 Diagnoses Of Renal Failure In Nevada. "In 2008 there were 4,134 diagnoses of renal failure in Nevada. The average length of stay was 5.19 days for both sexes. The average charge was $38,785." [Norah Langendorf, M.Ed, Nevada Compare Care, "Renal Failure & Kidney Transplants, A Comparison of Hospitals and Trends in Nevada," 2008] 368,544 U.S. Residents With ESRD Received Dialysis. In 2007, 368,544 U.S. residents with ESRD received dialysis. [National Kidney & Urologic Diseases Information Clearinghouse, accessed 8/21/11] NEVADA RANKED 48TH IN DOCTORS PER PATIENT AND "DEAD LAST" IN SPECIALTIES o Silver State Ranked No. 48 In Doctors Per Patient And "Dead Last" In Specialties. According to the Las Vegas Review Journal, "A 2009 study from the University of Nevada School of Medicine found that the Silver State ranked No. 48 in doctors per patient...'In specialties such as pediatric heart surgery, orthopedic surgery and spine surgery, the Silver State places 'dead last,' said Larry Matheis, executive director of the Nevada State Medical Association. So acute are the shortages that Nevada could double its number of pediatric-surgery specialists and still be last in the country for its share of doctors specializing in kids' care." [Las Vegas Review-Journal, 4/11/10] Nevada Has 190 Practicing Doctors Per 100,000 People. According to the Las Vegas Review Journal, "To understand how bad the state's shortages already are, consider that Nevada has 190 practicing doctors per 100,000 people. As of 2007, Nevada would have needed 262 practicing docs per 100,000 residents to post an average doctor-patient ratio, noted Dr. Annette Teijeiro, president of the Clark County Medical Society... The scarcity of physicians already means big wait times for nonemergency specialist care...It's gotten so bad that doctors and insurers increasingly send Nevadans out of state for specialty care because there aren't enough doctors here to handle the referrals." [Las Vegas Review-Journal, 4/11/10] o DOCTORS NO LONGER ACCEPTING MEDICARE BECAUSE OF LOW PAYMENT RATES Number Of Doctors Refusing New Medicare Patients Because Of Low Government Payment Rates Setting A New High. According to USA Today, "The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program. Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill. o The American Academy of Family Physicians says 13% of respondents didn't participate in Medicare last year, up from 8% in 2008 and 6% in 2004. The American Osteopathic Association says 15% of its members don't participate in Medicare and 19% don't accept new Medicare patients. If the cut is not reversed, it says, the numbers will double. The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%. o o The federal health insurance program for seniors paid doctors on average 78% of what private insurers paid in 2008." [USA Today, 6/21/10] Doctors No Longer Accepting Medicare, Either Because They Have Opted Out Of The Insurance System Or They Are Not Accepting New Patients With Medicare Coverage. According to the New York Times, "Some doctors -- often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists -- are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors' reasons: reimbursement rates are too low and paperwork too much of a hassle." [New York Times, 4/01/09] Medicare Payment Advisory Commission: 29 Percent Of The Medicare Beneficiaries It Surveyed Who Were Looking For A Primary Care Doctor Had A Problem Finding One To Treat Them. According to the New York Times, "In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state's doctors took new Medicare patients, only 38 percent of primary care doctors did." [New York Times, 4/01/09] BERKLEY CO-SPONSORED DIABETES BILLS Berkley Co-Sponsored Diabetes Prevention Access and Care Act. In 2003, Berkley co-sponsored H.R.1916, Diabetes Prevention Access and Care Act. The bill was referred to the Subcommittee on Health. [HR 1916, Introduced 5/01/03] Berkley Co-Sponsored Preventing Diabetes in Medicare Act of 2007. In 2007, Berkley co-sponsored H.R.2922, Preventing Diabetes in Medicare Act of 2007. The bill was referred to the Subcommittee on Health. [HR 2922, Introduced 6/28/07] BERKLEY'S OWN DIAGNOSIS OF OSTEOPOROSIS LED TO ADVOCACY ON THE ISSUE Berkley Was Lead Sponsor Of Osteoporosis Education and Prevention Act. In 1999, Berkley was lead sponsor of H.R.2294: Osteoporosis Education and Prevention Act of 1999. The bill was referred to the Subcommittee on Early Childhood, Youth and Families. In 2004, Berkley was lead sponsor of H.R.3803: Osteoporosis Education and Prevention Act of 2004. The bill was referred to the Subcommittee on Select Education. In 2005, Berkley was lead sponsor of H.R.1081: Osteoporosis Education and Prevention Act of 2005. The bill was referred to the Subcommittee on Select Education. [Thomas.gov, accessed 8/19/11] Berkley Was Lead Sponsor Of Medicare Fracture Prevention and Osteoporosis Testing Act. In 2007, Berkley was lead sponsor of H.R.4206: Medicare Fracture Prevention and Osteoporosis Testing Act of 2007. The bill was referred to House subcommittee. Status: Referred to the Subcommittee on Health. In 2009, Berkley was lead sponsor of H.R.1894: Medicare Fracture Prevention and Osteoporosis Testing Act of 2009. The bill was referred to the Subcommittee on Health. [Thomas.gov, accessed 8/19/11] Berkley Diagnosed With Osteoporosis And Said Her Experience Highlighted The Need For Serious Reforms To The Nation's Health Care System, Specifically The Services Provided By Group Medical Plans Or Health Maintenance Organizations. According to the Las Vegas Review-Journal, Democratic congressional hopeful Shelley Berkley "thought she had bad posture and nothing more last year when she reluctantly agreed to be tested for osteoporosis," but "the results of the bone scan were immediately obvious to her physician: Berkley was diagnosed with osteoporosis." Berkley has "responded well to 10 months of treatment, but one of the things she said she learned about the condition is how few women know they have it until it's too late and they break a bone. Worse, she said, few health insurance plans cover the cost of the simple bone scan that could detect osteoporosis in its earliest stages, when treatment can make a difference. Berkley said her experience highlights the need for serious reforms to the nation's health care system, specifically the services provided by group medical plans or health maintenance organizations." Berkley: "I believe it is time for Congress to guarantee that medical decisions will be made only by doctors and patients. We must ensure that our doctors' offices and clinics do not become assembly lines, as they have already in some cases." The Journal added, "The centerpiece of the legislation Berkley supports is the Democrats' Patient Bill of Rights, which would broaden coverage options for people covered by HMOs and managed care groups and guarantee treatment of conditions that require a specialist. Berkley focuses on HMO reform in a new television spot that will debut this week. The advertisement pokes fun at HMO accountants and urges support for a system that gives doctors more control." [Las Vegas Review-Journal, 9/30/98] BERKLEY WAS LEAD SPONSOR ON CANCER BILLS Berkley Was Lead Sponsor Of Nevada Cancer Institute Expansion Act. In 2006, Berkley was lead sponsor of H.R.6383: Nevada Cancer Institute Expansion Act. The bill was referred to the Subcommittee on Forests and Forest Health. In 2007, Berkley was lead sponsor of H.R.1311: Nevada Cancer Institute Expansion Act. The bill was placed on Senate Legislative Calendar under General Orders. Calendar No. 812. In 2009, Berkley was lead sponsor of H.R.234: Nevada Cancer Institute Expansion Act. The bill was referred to the Subcommittee on National Parks, Forests and Public Lands. [Thomas.gov, accessed 8/19/11] Berkley Was Lead Sponsor Of Medicare Lung Cancer Early Detection Promotion Act. In 2009, Berkley was lead sponsor of H.R.2578: Medicare Lung Cancer Early Detection Promotion Act of 2009.The bill was referred to the Subcommittee on Health. In 2011, Berkley was lead sponsor of H.R.1172: Medicare Lung Cancer Early Detection Promotion Act of 2011. The bill was referred to the Subcommittee on Environment and the Economy. [Thomas.gov, accessed 8/19/11]