In recent years, lawmakers have rightly focused on advancing racial equity and creating opportunities for the betterment of historically underserved communities.
Kidney disease experts say the latest proposed rules for Medicare reimbursement for dialysis are a missed opportunity. (Image credit: ©Hospital man – Stock.adobe.com)
The urgent need for such improvements is very clear for people living with end-stage renal disease (ESRD) or kidney failure. Although people of all races and ethnicities develop chronic kidney disease (CKD) at similar rates, ESRD disproportionately affects people of color.
The disparity is stark, considering that Black Americans make up 13% of the U.S. population; 35% of Americans They have kidney failure and are four times more likely than white people to develop this serious condition. Similarly, people of other races and ethnicities also face disparities when compared to whites.
Kidney transplantation is the treatment of choice, but transplant rates remain low. Currently, more than 90,000 people are waiting for a kidney transplant. Sadly, 13 people die every day While on the kidney waiting list. Given these trends, most people who develop ESRD require multiple dialysis treatments per week.
Despite these alarming numbers, the Centers for Medicare and Medicaid Services (CMS) latest proposed rule Medicare reimbursement for life-sustaining dialysis is a missed opportunity to support the kidney community by failing to address two key challenges that limit access to care for all but the most affected people of color.
The first challenge concerns innovation. The kidney patient community has been waiting for years for innovative products that can improve our health. There are many health issues that cannot be solved with dialysis alone. Promising new drug innovations have the potential to improve the lives of patients, and CMS should do everything it can to facilitate access to them.
But rather than supporting innovation, the agency’s proposed rules would stifle new treatment options for patients with kidney failure.
While we are glad that CMS recognizes that reimbursement rates facilitate patient access to innovative treatments, the proposal to add new funding for just three years does little to address long-term access. plug. This has created a cliff that means very few patients are prescribed drugs even when funding is available, and one of the reasons is that patients are forced to change or completely replace their drugs once their payment period expires. There are concerns that the event may have to be canceled in the future.
Additionally, the proposal would dilute the small amount of additional funding because the money would be distributed to all patients, rather than directed specifically to those who need the drug. As a result, facilities currently using the covered drug will pay less than his 89%, creating a significant financial disincentive for clinics to use this innovative product. .
Unless methodologies change so that money follows patients and the Medicare ESRD payment bundle is permanently adjusted to support innovation, people who need dialysis will continue to lack access to innovative treatment options . It also brutally undermines the hope that innovation brings to the kidney community.
The second major flaw in this proposed rule is its failure to recognize the staggering inflationary pressures that are negatively impacting dialysis workers. Over the past few years, the landscape of dialysis care has been transformed by rising labor and medical costs and workforce shortages that directly impact patient access to care. However, CMS is proposing reimbursement increases well below the rate of inflation. Only 1.6% In 2024.
Labor issues and labor shortages are a challenge for clinics across the country, especially in rural and underserved communities that already operate on razor-thin profit margins.
We regularly hear from people who are experiencing the impact of dialysis shortages first-hand. They are driving long distances for treatment because local clinics have had to close due to staff shortages or because there are long waiting lists for home dialysis training. Additionally, when patients are treated in clinics, they are not fully staffed, forcing clinics to focus only on emergencies and limiting or reducing the time they spend with patients.
CMS’s reluctance to keep up with inflation and make meaningful investments to expand access to new treatments hurts people living with kidney disease. Those who are hardest hit by this flawed approach are those living in already underserved communities, including people of color and people living in rural areas.
People living with kidney disease deserve better. But the proposed rule is far from supporting them. Additionally, the proposed rule would further exacerbate existing disparities in access and treatment and disproportionately impact already underserved communities.
CMS should reconsider this proposed rule to find a better way. Ideally, it would offer hope to the more than 562,000 Americans who rely on dialysis to survive, without compromising access to care.
Laverne Burton is President and CEO of the Kidney Foundation of America, Frant Jamgotian is CEO of Dialysis Patient Citizens, and Lori Hartwell is Founder and CEO of Kidney Support Network. is.
