The current Ryan budget would mean cuts to dialysis services

[Bill Peckham]

Dialyzors should know that the current Ryan budget, by cutting Medicaid funding, will negatively impact their care the day it goes into effect. Beyond the impact of the initial cuts, how the Medicaid block grants in Ryan’s plan would impact care would depend on the state you live in and that state's Medicaid funding choices but in many states the change would be disastrous.

Medicaid is an important part of the dialysis payer mix. Among the 400,000 people using dialysis in the US Medicaid is the primary insurer for over 10% and Medicaid is the secondary payer to Medicare for nearly 40% of all people using dialysis in the US (the "dual eligibles", who need Medicaid to pay the 20% left by Medicare).

The care every dialyzor receives is based on the average reimbursement at a unit. In a dialysis unit everyone uses the same machines, the same doctors, the same staff following the same policies and procedures, no matter how much your care is reimbursed. Even if you are in the first 33 months of using dialysis and are insured through an Employer Group Health Plan that is paying many times more than the Medicare (and by extension Medicaid) allowed rate your care, the level of care available to you, is based on the average reimbursement rate at that clinic.

The Medicaid cuts in the Ryan budget take effect immediately. Lower Medicaid reimbursement means more states will be paying less than 100% of the Medicare allowed rate, which means there will immediately be a lower average reimbursement for each treatment. A lower average reimbursement rate means less funding for the care everyone receives. The unit’s policies and procedures, its staffing levels, how often equipment is maintained/replaced all depend on the unit’s average reimbursement. When that goes down services decline. Medicaid cuts effect everyone.

[Rerun]

Maybe dialysis centers should cut their profit margens too.  We should come together here.  Why should the CEO be making milllions off Medicare/Medicaid and sick people.

We need to start from that point first.

[Bill Peckham]

Maybe dialysis centers should cut their profit margens too.  We should come together here.  Why should the CEO be making milllions off Medicare/Medicaid and sick people.

We need to start from that point first.

It doesn't matter if you are at an LDO or a nonprofit the care you are receiving today is based on average reimbursement at that unit. When that number goes down cuts have to be made.

also consider the math:
The cuts would be on the order of $20/treatment and impact half the unit's census, so the unit's average reimbursement would go down ~$10/treatment (conservatively, most likely states would cap Medicaid at 80% of the Medicare allowed - no dual eligible reimbursement - meaning the number would be $50, not $20; $25 not $10)

DaVita has about 130,000 patients, on average dialyzing 140 times a year, average reimbursement declines $10 that's $182,000,000. Not even Thiry's salary would make much of a dent in that.

[Rerun]

WHY should tax payers pay these high submitted charges of $55,000 a month when we ALL know they don't get that much.  If these dialysis centers would play by the rules maybe congress wouldn't look at them. 

If the CEO makes 29 million a year I think they could stand to cut some fat.  These dialysis centers if they stay in business will not let us go without dialysis.  This country is in a crisis.  Something needs to be done. 

Let's say a dairy farmer was selling milk (bad analogy) to people on dialysis at $200 a gallon and Medicare was paying for that.  And Ryan was going to make some cuts.  Because he could see that that dairy farmer was getting too much money for that gallon of milk.    Don't you think that the dairy farmer would maybe give a little and even come down to $50 a gallon and still make a pretty good profit? 

[Rerun]

Medicare and my secondary insurance also pay for my Doctor to come around once a month to see what movie I'm watching.  I'm thinking $300 a month x 130,000 = 39million that could be cut and no harm done.

I'm not required to see any other DOCTOR once a month for no reason!

[Rerun]

Let's see there are probably 30,000 people on dialysis who don't even KNOW where they are!!  REALLY?  Should tax payers be paying for nature NOT to take its course so the dialysis centers can MAKE Money hand over fist!

[Bill Peckham]

WHY should tax payers pay these high submitted charges of $55,000 a month when we ALL know they don't get that much.  If these dialysis centers would play by the rules maybe congress wouldn't look at them. 

If the CEO makes 29 million a year I think they could stand to cut some fat.  These dialysis centers if they stay in business will not let us go without dialysis.  This country is in a crisis.  Something needs to be done. 

Let's say a dairy farmer was selling milk (bad analogy) to people on dialysis at $200 a gallon and Medicare was paying for that.  And Ryan was going to make some cuts.  Because he could see that that dairy farmer was getting too much money for that gallon of milk.    Don't you think that the dairy farmer would maybe give a little and even come down to $50 a gallon and still make a pretty good profit?

Right now I'd say the Medicare allowed rate of $250/treatment seems like a bargain compared to what else people spend $250 on - that's the allowed rate on average, after all the case mix and geographic wage adjustments so for an individual it can be +/-$20. What they bill relates to what they charge private payers it has no effect on what Medicaid or Medicare pays.

[KarenInWA]

I totally see Rerun's point, but I don't believe that the fat will be cut out of the profits. The fat will be cut out of patient care, and that is just wrong, wrong, wrong. Until we get lobbyists for the for-profit centers (and drug companies, etc) out of DC we are going to continue to see inflated prices on all things medical.

KarenInWA

[Rerun]

Right now I'd say the Medicare allowed rate of $250/treatment seems like a bargain compared to what else people spend $250 on -

What at Starbucks?

That is $250 a treatment x 12 treatments a month which is $3000 a month.  That is $36,000 a year to stay alive. 
Could a dialysis center (mine as an example) stay in business with 10 chairs.  2 shifts a day plus nocturnal........
lets see at .... I'll just do per month  $180,000 a month?  I don't know.  But, how much of what that center makes stays there?  These dialysis centers have gotten BIG and now they are in a pickle.  Congress is not going to spend that much on us.  If we would have stayed small but NO.... then we asked for transplants and then medication for life and then extended dialysis.... WE are NOT the only people asking for and needing money!  We got greedy people.

Then the doctor gets another $18,000 a month for a 10 chair center.

Why are tax payers paying for me to see a doctor when I don't need to.  If I'm having problems then I could make an appointment like everyone else.  I have to do that anyway because I'm never having problems when he comes around once a month.

[Rerun]

Okay, we need to arrange for dialysis in DC and go there and get some FAT cut from the profits.  Make them come up with REAL figures of what dialysis costs and let them have a 10% profit.  That is all!   AND make Medicare cut the requirement for us to have to see a kidney specialist once a month for no reason.

The other day my Neph was going to draw me a picture of "Dry Weight".  I said I think BY NOW I know what dry weight is and if you draw me a picture I'm going to cut your hand off. 

[KarenInWA]

In regards to the monthly neph appointments - I can totally see requiring monthly appointments in the first year of dialysis, since it is such a big adjustment to one's body. It is important to establish a trusting relationship with your neph in regards to dialysis in that first year. And, of course, if the patient has issues, then yes, they should see their neph as often as is necessary. But once you're stable, and all is good? Not necessary! In my 7 months of being on dialysis (in-center) I never saw my neph while sitting in the chair. I only saw him at his office. So I do not know what the quick, 2-minute or less dr visit is like. I have to say, I am thankful for that, at least!

KarenInWA

[KarenInWA]

Another thing to bring up - why are those who do dialysis at home - be it PD or HHD - charged so damn much per month to do so??? Or, rather, their insurance companies are? I thought one of the perks of home care was to save money - no staff to pay (outside of the home care nurse), no building to pay for, utilities, etc. Why are home patients being gouged? This is also something that needs to be addressed. Those who do their treatment at home deserve to get a break on the cost of their care - it only makes sense to me! I keep reading posts, etc from people on both types of dialysis whose insurance companies routinely get charged $30K-60K a month. What is up with that???

KarenInWA

[Bill Peckham]

There is a lot to be done to make the provision of dialysis more efficient but the Ryan plan doesn't do that it simply caps spending. Which is fine. That's a political choice and we can have that debate but don't tell me it won't effect people currently using Medicare.

Beyond the impact via Medicaid outlined above, the Ryan plan repeals the Affordable Care Act too, which uses Medicare savings (the mythic 700 billion that was taken from provider reimbursement with little effect) to provide coverage for the uninsured but some of that money is used for services to existing Medicare beneficiaries. The donut hole is closed. And the new preventive medicine benefit is being used today:

In 2011, 32.5 million people in Medicare received one or more preventive benefits free of charge.
“Millions of Americans are getting cancer screenings, mammograms and other preventive services for free thanks to the health care law,” said Secretary Sebelius.  “These new benefits, made possible through the health care law, are helping people stay healthy by giving them the tools they need to prevent health problems before they happen.”

Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits such as cancer screenings.  Through the Affordable Care Act, preventive benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.

That's how our healthcare system can improve the lives of Medicare beneficiaries and those preventive health services again have a deductible and copay under the Ryan plan. We can talk about how to improve healthcare but it should not be said that the Ryan plan does not effect today's Medicare beneficiaries.

[rocker]

Let's see there are probably 30,000 people on dialysis who don't even KNOW where they are!!  REALLY?  Should tax payers be paying for nature NOT to take its course so the dialysis centers can MAKE Money hand over fist!

So, are you suggesting death panels?

Who should have the power to make those decisions?

[KarenInWA]

Let's see there are probably 30,000 people on dialysis who don't even KNOW where they are!!  REALLY?  Should tax payers be paying for nature NOT to take its course so the dialysis centers can MAKE Money hand over fist!

So, are you suggesting death panels?

Who should have the power to make those decisions?

No, I don't think Rerun is talking "death panels", but we do need to face reality, here. The policy that brought up the whole "death panel" hysteria in the first place had to do with planning end-of-life care. It is cruel and unusual punishment to make an older person who is not in good health and certainly not in their right mind to have to endure dialysis, which can be very painful and uncomfortable, especially when one has such a fragile, older body. In these cases, it is not the patient who is making these decisions, it is usually a caretaker, most likely an adult child, who does not want to let go. Most of the time, the humane thing to do is to let nature take its course. My family had to do that with my Grandma 4.5 years ago. We loved her too much to have her go on dialysis, in a body that was already dying and riddled with a newly found leukemia.

KarenInWA

[boswife]

Another thing to bring up - why are those who do dialysis at home - be it PD or HHD - charged so damn much per month to do so??? Or, rather, their insurance companies are? I thought one of the perks of home care was to save money - no staff to pay (outside of the home care nurse), no building to pay for, utilities, etc. Why are home patients being gouged? This is also something that needs to be addressed. Those who do their treatment at home deserve to get a break on the cost of their care - it only makes sense to me! I keep reading posts, etc from people on both types of dialysis whose insurance companies routinely get charged $30K-60K a month. What is up with that???

KarenInWA

oh boy Karen, im with you on this one!!!!  it makes me so mad as it is rediculous the charge to our insurance when a huge cost of dialysis  is that of "employees"