Nation's Kidney Community Deeply Concerned Over Government's "Untenable" Proposed Cut to the Nation's Medicare's Dialysis Program

Jul 22, 2013, 13:42 ET from Kidney Care Partners

Proposed Cut of 12 Percent Would Lead to Facility Closures, Significantly Impact Patient Care, Quality

WASHINGTON, July 22, 2013 /PRNewswire-USNewswire/ -- The following is being released by Kidney Care Partners:

On July 1, the Centers for Medicare and Medicaid Services (CMS) – the government program that oversees Medicare – put forth a proposed rule cutting funding for dialysis by 12 percent,** or $30 per treatment to the payment rate that Medicare would otherwise pay for calendar year 2014. The cut, if finalized, would fail to cover the cost for each 3-4 hour dialysis session for Medicare beneficiaries with kidney failure. 

Medicare covers nearly 85 percent of the more than 400,000 patients with kidney failure who rely on this program for their life-sustaining dialysis care at a modest reimbursement level. Because of the heavy reliance upon Medicare to cover this care, the kidney care community, including patients, physicians, nurses, dialysis facilities, and manufacturers, were alarmed by the Agency's proposal that does not take into the account the cost of providing care to beneficiaries.

"Dialysis providers are struggling to absorb and adjust to the other Medicare cuts made to the program in recent years," said Ron Kuerbitz, Chair of Kidney Care Partners. "As government data clearly show, Medicare barely covers the cost of providing dialysis to ESRD patients, even before the impact of sequestration-related cuts. The current proposal is untenable, and would dramatically underfund this crucial therapy for Medicare beneficiaries on dialysis. To protect the well-being of our patients, CMS must ensure that Medicare reimbursement is adequate to cover the cost of providing quality care."

According to a non-partisan, independent government advisory group and other health officials, currently, Medicare barely covers the basic cost of care for dialysis. If the recent proposal is finalized, a 12 percent cut would push the vast majority of facilities into the red, forcing very difficult decisions that could ultimately hurt the very patients for which the Medicare program is charged for their care. For the first time, the commitment made to Americans with end stage renal disease forty years ago is in doubt.

Patient and professional organizations across the country agree that if the proposed rule becomes finalized in November, the cuts could have a devastating impact on the integrity of the nation's Medicare dialysis program, resulting in staff reductions, closures, and patient access issues -- especially in some rural and inner city facilities.  The community is therefore urging CMS to reverse course before the rule is finalized. 

The following are excerpts from public statements made by myriad groups within the broader kidney community in response to the proposed rule. 

American Kidney Fund:

"Such a drastic cut in services to this vulnerable group of patients is unconscionable, especially on top of other cuts in the dialysis payment system in recent years.  If this rule is finalized, it is going to limit patients' access to dialysis and reduce their options for care."

AKF is the nation's leading charitable assistance fund to assist dialysis patients who need help with the costs associated with treating kidney failure. Last year, nearly 84,000 people—1 out of every 5 U.S. dialysis patients—received assistance from the American Kidney Fund for health insurance premiums and other treatment-related expenses.

American Nephrology Nurses' Association:

"…the federal cuts will have enormous repercussions in the kidney community…some patients could lose quality care and access to the treatments they need to survive."

ANNA is a non-profit association representing more than 10,000 registered nurses and other health care professionals at all levels of practice, promoting excellence in and appreciation of nephrology nursing to make a positive difference for people with kidney disease.

American Society of Nephrology:

"People with kidney disease, among the most vulnerable patients, are disproportionately underrepresented minorities, and such a large cut may reduce access to care and quality of treatment."

The American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

Dialysis Patient Citizens:

"We cannot recall a time where CMS has proposed such a deep cut for any patient group, and are concerned that it would chose to do so for the treatment of some of America's most vulnerable citizens. While we recognize that CMS was instructed by Congress to adjust dialysis payment based on recent changes in utilization, no one in the kidney community expected CMS to propose such a devastating cut."

DPC is a nationwide, non-profit, patient-led dialysis organization with membership open only to dialysis and pre-dialysis patients and their families. With more than 23,000 dialysis and pre-dialysis patients, DPC works to improve the quality of life for all dialysis patients through education and advocacy.

Kidney Care Council:

"Adequate Medicare reimbursement is not optional for dialysis facilities.  Medicare barely covers cost of care for most dialysis facilities and, in fact, nearly 35% of dialysis facilities across the country operate with negative Medicare margins….Cuts of this size proposed by CMS put access to care for the most vulnerable patients in urban and rural settings at risk."

The Kidney Care Council (KCC) is a nonprofit national health care association based in Washington, D.C. and comprised of thirteen of the leading kidney dialysis provider companies in the United States. Collectively, the KCC members provide End Stage Renal Disease.

National Kidney Foundation:

"Currently, across all dialysis providers, Medicare profit margins are only 3-4 percent (as estimated by the Medicare Payment Advisory Committee – MEDPAC)….NKF is concerned that some providers may not be able to withstand cuts and will have to close facilities and that many others may have to eliminate patient-focused programs, services, and benefits that improve patients' health and quality of life."

The National Kidney Foundation, a major voluntary nonprofit health organization, is dedicated to preventing kidney and urinary tract diseases, improving the health and well-being of individuals and families affected by kidney disease and increasing the availability of all organs for transplantation.

Renal Physicians Association:

"Further cuts on the scale of those outlined in the proposed rule will not only compromise the ability of most dialysis facilities to maintain the staffing levels necessary to provide appropriate care to Medicare beneficiaries with ESRD, but will also increase the likelihood that some dialysis facilities will be forced to close their doors.  Additionally, the reductions are likely to have a disproportionately negative impact on rural communities and efforts to address health care disparities in the ESRD patient population."

Since 1973, the non-profit, 3,500 member Renal Physicians Association (RPA) has been dedicated to representing and serving nephrology practitioners in their pursuit and delivery of quality renal health care. RPA members are comprised of physicians, physician assistants, advanced nurse practitioners and practice managers. RPA programs focus in the areas of practice management, public policy and quality patient care. RPA serves as the voice of nephrology practice and a committed advocate to the renal community, payers and federal policy makers.

Renal Support Network:

"….it is incomprehensible to propose such an ill-advised cut on a program for this vulnerable patient population.  These cuts will impact hundreds of thousands of people who require dialysis in order to survive, especially patients in rural and inner city facilities."

Renal Support Network (RSN) is a nonprofit, patient-focused, patient-run organization that provides non-medical services to those affected by chronic kidney disease (CKD).

** The CY 2014 proposed base rate per treatment of $246.47 would be reduced by $29.52, the adjusted difference between the 2007 and 2012 per treatment amount, resulting in the CY 2014 proposed ESRD PPS base rate of $216.95. This adjustment results in an overall 12 percent reduction in Medicare payments for CY 2014.  {Source:  CMS FACT SHEET}

SOURCE Kidney Care Partners