Cuts Could Mean Loss Of Dialysis Care For Thousands Of Americans

[okarol]

Cuts Could Mean Loss Of Dialysis Care For Thousands Of Americans

Hundreds of thousands of Americans who need dialysis care could lose that service next year.

That’s if a plan to cut almost 10 percent from costs of drugs used in a dialysis care pass.
If you want to read more about the plan, you can see the compete Medicare report at
this site http://ofr.gov/ofrupload/ofrdata/2013-16107_pi.pdf

If you want to voice your opinion about the plan to cut suppport for dialysis patients, you can do so online.
Just go to this site http://www.regulations.gov/#!home Follow the links to submit a comment.

[lmunchkin]

I can't read this Karol.  It makes me sick to think about it! 

lmunchkin

[Wildrose]

Makes me sick too 

[BattleScars]

I can't read all of that but I did skim through. I'm not seeing where we would lose access to care. Not saying it's not there but could somebody explain this in layman's terms and give us the short version?

[jeannea]

Short version: The payment your center receives for each treatment and each drug will be cut by some percentage. The centers will have to find a way to make some money even though each patient is paying less. They could get less trained staff, cut back on the drugs you get, cut back on your treatment time, try to not take the worst patients, be cheap with supplies, etc. you imagine the options. In the long run, some centers may go too deeply into the whole to survive and will close. Other centers may never open.

[Rerun]

I guess if they can't make millions off us they will close.  Maybe someone will stay open for a profit of hundreds of thousands.

I hope.

[Cowdog]

Page 33, 2nd paragraph, "While we propose to implement the full reduction in CY 2014, we note that we are also
concerned that this one-time reduction to the ESRD PPS base rate could be a significant
reduction to ESRD facilities for the year and potentially impact beneficiary access to care."

If they admit they are concerned they're pretty sure there will be a problem. These are the guys who think everything they do will work. Lots of references to cuts driven by the Affordable Care Act. Put rules in place to reduce the number of people recieving treatment and overall dialysis cost to the system will come down.

[jeannea]

Cowdog, you are amazing being able to read that so carefully. My attention span runs out.

[charmed]

I am in the Uk and thank God for the NHS.  

I have been studying a little and could be wrong but maybe my friends in the us should take a look.

So I had a vascath line in for 6 yers after my transplant failed. machine speed 450; clearance kt/v 1.8 I had a fistula done and its a baby so cannot do high pump speeds. using little orange needles.  pump speed 200, they just did monthly bloods and my kt/v is 1.4. That's .4 difference. My point is:

1: we should try to use fistulas where possible,
2: change our diet so we don't need as much dialysis,
3: I am not saying this is good but I go to the sauna to remove fluids and some toxins, maybe a little change of life style would help.

your thoughts friends... all welcome.

[Whamo]

Looks like the government is cutting health benefits anywhere they can.  Don't worry, though, the trillions hidden offshore are safe from the government.

[NDXUFan]

Short version: The payment your center receives for each treatment and each drug will be cut by some percentage. The centers will have to find a way to make some money even though each patient is paying less. They could get less trained staff, cut back on the drugs you get, cut back on your treatment time, try to not take the worst patients, be cheap with supplies, etc. you imagine the options. In the long run, some centers may go too deeply into the whole to survive and will close. Other centers may never open.

In other words, they will continue what they have been doing for years.

[NDXUFan]

Cuts Could Mean Loss Of Dialysis Care For Thousands Of Americans

Hundreds of thousands of Americans who need dialysis care could lose that service next year.

That’s if a plan to cut almost 10 percent from costs of drugs used in a dialysis care pass.
If you want to read more about the plan, you can see the compete Medicare report at
this site http://ofr.gov/ofrupload/ofrdata/2013-16107_pi.pdf

If you want to voice your opinion about the plan to cut suppport for dialysis patients, you can do so online.
Just go to this site http://www.regulations.gov/#!home Follow the links to submit a comment.

I think too much Epogen is being given, I think this is more about profits than anything else.  I cannot work up any sympathy for Davita @ $118.00 per share(Wall Street Journal).  I was at Davita for five years, they have always been cheap. 

[jeannea]

Please don't use a sauna unless you know what you're doing. You could hurt yourself.

I agree patients should watch their diets and take care of themselves. But it's hard to be perfect.

[plugger]

Somehow the Italians have been scraping by on a lot less than we spend here:

"Italy has one of the lowest mortality rates for dialysis care -- about one in nine patients dies each year (in Italy), compared with one in five here. Yet Italy spends about one-third less than we do per patient.

http://www.propublica.org/article/in-dialysis-life-saving-care-at-great-risk-and-cost

Kent Thiry may have to skimp on his parties - pity:

http://www.5280.com/magazine/2012/09/strangest-show-earth

[jeannea]

I just don't even know how to deal with this anymore. I'm so tired of being a second-class citizen because I was born with kidney disease. I can't go back to work even after my transplant because the encephalitis I had really damaged my brain. But of course I will have to constantly prove I am disabled and in a few years they will decrease the amount I get on disability. I wish I felt some hope for my future but I don't.

[rocker]

For those who don't want to slog through it, here's the short version.

This is all about drugs like iron and Epogen.

When the bundle was first proposed, Medicare had statistics on how much drugs were being used by the clinics and what they cost.  They took that into account when setting the bundle price.  After the bundle was instituted, clinics cut way back on the amount of drugs they were giving to patients.  In response to the cutbacks by the clinics, Medicare is cutting their reimbursement.  They aren't using as much, they won't be paid as much.

The background on this is that Medicare used to pay clinics for the cost of the drugs they bought, plus an extra fee meant to cover the costs of giving those drugs.  This meant that the more drugs clinics gave, the more profit they made. There have been several high-profile lawsuits charging that clinics had corporate policies in place to maximize the amount of drugs both given to patients, and the amount thrown away.  Because they made a profit on whatever they bought.

So the government decided to put a stop to that particular gravy train, and ordered that the drugs be included in one set price.  So obviously the clinics ended their policies of "using as much as possible", and went to a policy of "using as little as possible".  (There were several stories on IHD of people who used to get Epo in the lines during dialysis, who were abruptly told "You're getting injections now".  Epo is far more effective when injected under the skin than when given IV.) Drug usage dropped like a rock, and so did the cost to the clinics.

So now Medicare looked at that and says "Since your costs have dropped so much, we are not going to pay you as much."

This cut is a reaction to cuts in care that have already happened - not a cause of them.

Of course the corporations are organizing petition campaigns and the like - they want to protect their profits.  After all, they have shareholders to think of!

[Bill Peckham]

Well put Rocker. The advocacy messages I've been seeing have been pretty bad, they're all along the line, the cuts would be devastating, don't make the cuts. It reminds me of the comments to the proposed bundle in 2010 that were along the line, the bundle is bad, do not bundle. In 2010 those sort of comments had zero effect and I believe those sort of comments will have zero effect today. It is almost as if the LDOs that set the community's advocacy agenda don't want any changes to the proposed cuts. As if they want the consolidation that will result if the proposed rule is finalized as is ... but wait that's just me being cynical 


I think there were some very good comments in 2010 that had an impact but it seems as if the community has forgotten the lesson of what makes for a good comment. You have to make specific points based on the legislation and the legislation that went before it. Not just say it is bad, or that CMS is crazy. CMS is bound by law to act on legislation passed through Congress and signed by the President, it has to rebalance the payments, just as it had to institute a bundle. COmments could have the effect of mitigating the cuts but those aren't the sort of comments the community seems intent on making.

[cdwbrooklyn]

Thanks for explaining this.  I was very confused as to why people are complaining about less payments.  My payments are $3000 per treatment; that's $3000 x 5 = $15,000 a week.  You do the math for the year.  Luckly, Medicare is my primary and my job insurance is my secondary because I would not have a job because my treatments will run my job broke.  Anyhoo, Medicare is not paying $3000 per treatment and Davita cannot charge me or my insurance company the balance.  It's against the law as long as I am under Medicare.   

[amanda100wilson]

Rocker, you are absolutely right, and NDXUfan,  and too much epogen is not being used.  Since  a stop was put on the providers being able to milk the system on payments for epo, blood transfusion rates for dialysis patients have increased, i.e. people are not being given enough epo.

[Hemodoc]

Rural dialysis centers whether belonging to the large dialysis organizations or some of the remaining independents and smaller dialysis organizations  will likely experience the greatest impact. Medicare reimbursement is already barely covering costs at present. It is undeniable that a nearly 10% cut will severely impact care for 400,000 dialysis patients whose primary provider is Medicare.

Unfortunately, CMS is likely to place a deaf ear to these cuts since it was not only the bundle that is promoting this, but the recent American Taxpayer Relief Act (ATRA). The recourse to lobbying CMS is of course going to congress for action. However, with CMS responding to the recent ATRA legislative act, they are also likely to have a deaf ear to advocates demanding they rescind these cuts. Long and short, the cuts are likely to stay especially given the overwhelmingly apathetic dialysis population where only a very small percentage of patients are involved in dialysis advocacy.

This will only fuel the already rampant consolidation of the dialysis industry. A few years ago, the feds kept changing the the standards on indwelling below ground gas tanks for gas stations. Stations had to upgrade to a new tank and rip up the old and install a new. Soon after, they had to do it all over again when the standards were upgraded again a relatively short time later. The mom and pop gas stations essentially disappeared when they could no longer afford to keep up with the latest regulations. The relationship between government regulations and industry consolidation is evident over and over again.

http://www.nytimes.com/1989/06/19/us/fuel-leak-rules-may-hasten-end-of-mom-and-pop-service-stations.html

The dialysis industry unfortunately, aided by congressional legislative action continues to march along this path to dialysis monopolies.

[Alex C.]

......  My payments are $3000 per treatment; that's $3000 x 5 = $15,000 a week.  You do the math for the year.....

Well, not really. That $3k price is the price they might charge to those who have no insurance. In reality, Medicare sets the price that they are going to pay, and that's what they pay, not a penny more or less. The price you mention (and that they post on certain paperwork) has no reflection in reality. It's like the prices they post for furniture; nobody actually pays full price. After sales, discounts, deals, etc., people pay a LOT less than the 'posted price', and as a result, they think they've scored a big deal, when in fact, they've more or less paid what anybody else would.

In reality, Medicare pays something in the region of $500/$700 per dialysis session average.

[PatDowns]

In reality, Medicare pays something in the region of $500/$700 per dialysis session average.

If a dialysis patient has private or group health insurance, it is the primary payer for the first 30 months of dialysis.  The dialysis provider can CHARGE whatever it wants and in the majority of situations, works out a negotiated payment with the insurance companies.  It is much much more than what medicare approves.

Now, after 30 months Medicare becomes the primary payer and a patients health insurance becomes secondary.  Medicare's APPROVED RATE per treatment is $200-$350 depending on what area of the country you live.  It PAYS 80% of that approved rate.  Patients are responsible for the 20% balance.

[PatDowns]

Long and short, the cuts are likely to stay especially given the overwhelmingly apathetic dialysis population where only a very small percentage of patients are involved in dialysis advocacy.

ESRD patients are some of the worst at self advocacy.  Vast majority would rather bitch, moan and play the victim role as opposed to actually trying to do something constructive.  Interestingly, over half already rely on some sort of government subsidy/entitlement such as food stamps, title 8 housing, medicaid, etc.  Demographically, dialysis patients are not an influential subset of population. 

[Hemodoc]

Long and short, the cuts are likely to stay especially given the overwhelmingly apathetic dialysis population where only a very small percentage of patients are involved in dialysis advocacy.

ESRD patients are some of the worst at self advocacy.  Vast majority would rather bitch, moan and play the victim role as opposed to actually trying to do something constructive.  Interestingly, over half already rely on some sort of government subsidy/entitlement such as food stamps, title 8 housing, medicaid, etc.  Demographically, dialysis patients are not an influential subset of population.

Nor are we a large group either. At 400,000, we are costly but lack the numbers to influence our own outcome even if we were vocal and effective advocates. Nevertheless, that is not an excuse for us to not do more.

[PatDowns]

Nor are we a large group either. At 400,000, we are costly but lack the numbers to influence our own outcome even if we were vocal and effective advocates. Nevertheless, that is not an excuse for us to not do more.

The largest components of the dialysis population are the elderly/blacks/latinos.  AAKP made a huge mistake in the 1980-1990s by not partnering w/AARP and NAACP.  Could have been vocal and effective advocates for us.  Turf protection and hubris.  But then again, forward-thinking has never been a descriptor for AAKP - even during the days of Dr. Lundin.