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Author Topic: DSEN: Deeply confused New York Times article is a disservice to dialyzors  (Read 5698 times)
Zach
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« on: April 01, 2011, 12:17:24 PM »

Deeply confused New York Times article is a disservice to dialyzors
http://www.billpeckham.com/from_the_sharp_end_of_the/2011/04/deeply-confused-new-york-times-article-is-a-disservice-to-dialyzors.html

Dialysis from the sharp end of the needle
By Bill Peckham
April 01, 2011

RenalWeb (http://www.renalweb.com/) links to a front page New York TImes article "When Ailments Pile Up, Asking Patients to Rethink Free Dialysis" (http://www.nytimes.com/2011/04/01/health/01dialysis.html) by Gina Kolata. This is the article's leed:

Of all the terrible chronic diseases, only one — end-stage kidney disease — gets special treatment by the federal government. A law passed by Congress 39 years ago provides nearly free care to almost all patients whose kidneys have failed, regardless of their age or ability to pay.

Access to Medicare does not equate to "nearly free care" and not everyone is provided Medicare access.

Right now Medicare leaves about $50 per treatment unpaid and the responsibility of the beneficiary (Medicare routinely pays 80% of approved charges). Given 156 treatments a year this amounts to about $7,800/year unpaid, just for the dialysis ... in addition the beneficiary incurs 20% of the cost of doctors, nondialysis medications and any other medical care required outside the dialysis unit.

Also, not all individuals with ESRD are eligible for Medicare, about 10 to 15% will never have access because in addition to a diagnosis of ESRD, one of the following criteria must be met (PDF link http://www.kidney.org/professionals/cnsw/pdf/ESRD_medicare_guidelines.pdf):

1. The individual must meet the required work credits under Social Security, Railroad Retirement or as a government employee
2. The individual is receiving Social Security or Railroad Retirement benefits
3. The individual is the spouse or dependent child of a person who has met the required work credits or is receiving Social Security or Railroad Retirement benefits.

Currently the required work credits under Social Security is 40 quarters - 10 years of paying into the program - there is a detailed explanation here (http://www.ssa.gov/dibplan/dqualify2.htm).

But the article's error laden leed is not even its worse offense. It continues:

But the law has had unintended consequences, kidney experts say. It was meant to keep young and middle-aged people alive and productive. Instead, many of the patients who take advantage of the law are old and have other medical problems, often suffering through dialysis as a replacement for their failed kidneys but not living long because the other chronic diseases kill them.

No no no. Dialyzors who are "old and have other medical problems" have access to Medicare due to age or disability (http://www.billpeckham.com/from_the_sharp_end_of_the/2011/03/how-large-is-medicares-esrd-entitlement.html), "patients who take advantage of the law" are few: only about 25,000 people have access to Medicare as a consequence of Section 299I of the Social Security Amendments of 1972.

The article does shine a light on an important discussion about end of life care and informed consent. That's an important subject, however, it is only tangentially related to the ESRD Entitlement. The point of the article is that caring for the elderly is expensive and aggressive treatment may not always be in the interest of the ill. That is a serious discussion our electorate should have but has not been able to have; this article makes that discussion even more difficult.
« Last Edit: April 01, 2011, 12:23:36 PM by Zach » Logged

Uninterrupted in-center (self-care) hemodialysis since 1982 -- 34 YEARS on March 3, 2016 !!
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« Reply #1 on: April 07, 2011, 06:58:45 PM »

We always have enough money to blow massive holes in countries that annoy us, but not enough to let our elderly choose when they go?

If the author is worried about saving money maybe she ought to look into the history of dialysis.  Some stats that have stuck in my brain are from '91 to '01:

1.  From ’91 to ’01 expenditures for End Stage Renal Disease nearly tripled, while the number of patients only doubled – yet deaths were up 123%

www.usrds.org Annual Data Report 2003 pg 172, population up 106%, deaths up 123% from ’91 to ‘01 (I should add the for-profit companies – such as Davita – were taking over this area of medicine during this time period)

"In 1991 Medicare expenditures were $5.8 billion, and non-Medicare costs from heath plans and other coverage were $2.2 billion—a total, then, of $8.0 billion from all sources (see Figure p.6 on page 17). By 2001, costs of the program had reached $22.8 billion, almost triple the earlier level of expenditures"
2003 USRDS Annual Data Report

http://www.dialysisethics2.org/index.php/Our-Concerns/fact-sheet.html
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plugger
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« Reply #2 on: April 07, 2011, 07:00:38 PM »

Think patient care can be eliminated as a drain.
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Proud member of DialysisEthics since 2000

DE responsible for:

*2000 US Senate hearings

*Verified statistics on "Dialysis Facility Compare"

*Doctors have to review charts before they can be reimbursed

*2000 and 2003 Office of Inspector General (OIG) reports on the conditions in dialysis

*2007 - Members of DialysisEthics worked for certification of hemodialysis
technicians in Colorado - bill passed

*1999 to present - nonviolent dismissed patients returned to their
clinics or placed in other clinics or hospitals over the years

On my tombstone: He was a good kind of crazy

www.dialysisethics2.org
lawphi
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« Reply #3 on: April 09, 2011, 12:10:08 PM »

Congress gave the largest incentive for drug, research and surgical development by extending medicare to ESRD patients. 

Anytime you have a large insured patient base, you drastically increase incentives for development.  Most of the developments help patients without kidney issues, like autoimmune diseases, blood cancers and other organ failure.  There would be no cellcept or prograf without Medicare.
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« Reply #4 on: June 07, 2011, 01:11:07 PM »

Is anyone sending a letter to the editor refute the article?
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« Reply #5 on: April 27, 2012, 12:39:00 PM »

Did anyone end up sending  such a letter?  I don't feel like I  know enough to write a proper response.
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