Dialysis centers hit by state cutback in patient reimbursement

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Dialysis centers hit by state cutback in patient reimbursement

By LIZ FREEMAN

Tuesday, July 1, 2008

Dialysis patients signed petitions but it didn’t do any good.

Lobbyists for companies that operate dialysis centers told state lawmakers the cutback was a bad idea but it did little good.

In the end, Florida’s new budget that went into effect Tuesday reduces reimbursement to dialysis centers for treating Medicaid patients. The move saves an estimated $1.9 million statewide this year.

That may seem prudent but officials at dialysis centers say they already were losing money on Medicaid patients and this worsens the situation, to the point where they are expected to say “no more” to these patients, said Bob Loeper, president of the Florida Renal Administrators Association and director of the Florida Renal Coalition.

“In reality, the government will be increasing costs by patients staying in the hospitals longer,” Loeper said, adding the increased cost to hospitals could add up to $20 million more a year. “It’s going to be a mess. My advice to my colleagues in the renal community is to make a lot of noise out there.”

Specifically, the state Medicaid program now will pay outpatient dialysis centers $95 each time a dialysis patient comes in for a treatment three times a week. That’s down from $125 before for each dialysis session, while the average cost for each treatment is about $155, he said.

Loeper estimates the new payment cut will mean reduced reimbursement of $10,000 for each Medicaid patient and that hit isn’t sustainable for dialysis centers with a lot of Medicaid patients.

At Fresenius Medical Care, which operates 85 clinics in Florida with several in Collier and Lee counties, the company will start scaling back on accepting new Medicaid patients.

“At Fresenius, we are going to push back hard,” he said. “You can’t take the patients. If we start to get flooded with Medicaid patients, it will sink the clinic and it goes out of business.”

Carol Work, manager of Naples Artificial Kidney Center in North Naples, said some of the Medicaid patients are aware of what’s happening but are being assured they will continue getting their medical care.

When dialysis centers and lobbyists were hoping to convince state lawmakers the reimbursement cut was not a good move, patients signed petitions that were sent to Tallahassee, she said.

“They get the short stick all the time,” Work said.

Sarah Knott, lead social worker with Fresenius in Tampa, said Fresenius will continue serving current Medicaid patients but going forward is when clinics and hospitals will be in a bind.

“Discharge planners at hospitals can’t discharge anyone until an outpatient dialysis will take them,” she said.

Medicaid patients needing dialysis will have to stay in the hospital until they can qualify for Medicare after 90 days, she said.

Medicare law has an unusual circumstance in that a person with chronic renal failure can get Medicare coverage for dialysis, assuming the person has worked long enough to qualify for Medicare, Knott said.

The Florida Renal Coalition estimates the state will end up paying as much as $750 a day for 90 days until a patient can get on Medicare and be discharged for outpatient dialysis, which adds up to $67,500 for each patient. That compares to $4,500 for the 90 days at an outpatient center for dialysis if the state stuck with the $125 per dialysis treatment, the coalition says.

Another scenario is that hospitals will stabilize the patient, discharge them and pay the outpatient dialysis centers the $30 difference to provide the dialysis until the patient can qualify for Medicare, said Phil Dutcher, chief operating officer for the NCH Healthcare System.

That’s less costly than having the patients in the hospital for 90 days but it’s far from ideal, he said.

“Once again the hospital is the solution when the state continues to make cuts,” he said.

Loeper, with the renal coalition, said hospitals are rightly angry but the dialysis centers and patients are caught in the middle.

“Push the anger back where it belongs — at the Legislature,” he said.

http://www.naplesnews.com/news/2008/jul/01/dialysis-centers-hit-state-cutback-patient-reimbur/