In 2011, the Medicare benefit for ESRD took a major step forward and expanded what was one of the first bundled payments systems in the outpatient setting. Under this new payment system, health care providers would be paid a single rate for the dialysis treatment and nearly all of the ancillary items associated with it, including, for example, intravenous drugs and lab tests. What’s more, for the first time in Medicare’s history, reimbursement would be tied directly to quality. If a provider failed to meet certain quality thresholds, reimbursement would be reduced.
Far from resisting the change, dialysis providers embraced and even advocated for the new system. We recognized that by taking greater accountability for our patients’ care, we could improve their lives and reduce the cost burden for taxpayers. The new system was a sea change, one that we accepted with near unanimity. And by any measure, it has been a success. According to the government’s own data, patient mortality has improved, hospitalizations have declined and the cost of dialysis has been reduced. Nephrologists and dialysis providers are working together to improve patients’ lives and reduce the burden to taxpayers.
This success, however, is now in jeopardy. On July 1 — 40 years to the day that the Medicare ESRD benefit went into effect — the federal government released a proposal to dramatically cut dialysis reimbursement. Mandated by Congress to reflect providers’ efficiency in reducing the cost of care, the cut goes too far. Indeed, if the proposal is finalized, Medicare would fail to cover the basic cost of dialysis. For the first time since Shep Glazer testified before Congress while receiving dialysis treatment, the commitment made to Americans with kidney failure is in doubt.
What had been available to only a precious few prior to 1972 — a chance at life — is now available to virtually all kidney patients. What was once exceptional has now become routine. All because of the courage of patients like Mr. Glazer who challenged their lawmakers to dream of something bigger. Today, we must again look to our lawmakers in Washington and challenge them to live up to the commitment they made 40 years ago. They can make the routine even more efficient and more effective. If they fail to act, however, access to this life-saving therapy may be in jeopardy for some ESRD patients.
We can and must do better.
Ron Kuerbitz is the chairman of Kidney Care Partners, a coalition working to improve quality of care for individuals with chronic kidney disease and end stage renal disease.
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