The lives of 300,000 Americans with kidney failure depend on three-a- week dialysis treatments, yet the Medicare reimbursement rate is not only less than the actual cost, in real dollars it’s less than it was in 1983.
End-stage renal disease, or ESRD, often afflicts diabetics. As the population ages and obesity (which can trigger diabetes) increases, more Americans are likely to suffer kidney failure. Only a few will get transplants; the rest must have dialysis.
Medicare funds treatments for about 90 percent of the patients on dialysis. But dialysis rates aren’t automatically adjusted for inflation like other Medicare payments. Troy Zimmerman, government relations director for the National Kidney Foundation, says, “To get an increase, you have to go back to Congress.”
A proposal to change that is before Congress. Nearly 100 representatives, including Bob Beauprez, R-Colo., are sponsoring HR 1298 offered by Rep. Dave Camp, R-Mich. Fifteen senators have signed on to S 635, introduced by Sen. Rick Santorum, R-Pa.
Medicare reimbursement averages $130 per treatment. Adjusted to 2005 dollars, the 1983 rate was $4 higher. The actual cost averaged $152 per treatment. “Some dialysis units lose money or break even at best,” Zimmerman said. The shortfall is made up on other items covered by Medicare or from private insurance policies. But private plans typically cover dialysis only for about 30 months, and so most ESRD patients end up on Medicare.
“At first blush, it’s a strongly bipartisan bill,” said Josh Freed, spokesman for Rep. Diana DeGette, D-Colo., who often has championed health-care issues. “And the congresswoman is obviously concerned about making sure that ESRD patients receive the best care possible. One question we have is whether this is the best legislative proposal to address this question, and that’s what we’re still determining.”
He noted that the bill must be viewed in the context of other spending needs. Though the Congressional Budget Office hasn’t done a formal analysis, the Kidney Foundation estimates that automatic increases would cost about $1.5 billion over 10 years.
In Denver alone, about 650 kidney patients receive dialysis. Few issues are so critical to the survival as dialysis for ESRD patients, and this funding reform deserves the attention of Congress.
