Sequestration could sever lifelines to kidney care

While the ongoing Congressional debate about deficit reduction and Medicare may seem far removed for most Americans, it is an issue that strikes very close to home for one particular group of patients: the approximately half million Americans living with kidney failure (also known as end stage renal disease). For this group of patients Medicare functions as a lifeline, ensuring access to three-times weekly dialysis treatments that are crucial to survival.

Literally, without dialysis or a transplant, individuals with kidney failure would die.

Americans with kidney failure require regular dialysis treatments to cleanse their blood of toxins – along with other supportive drug therapies – in order to survive. Patients with kidney failure are a truly unique patient population – more than 80 percent of Americans with kidney failure are Medicare or Medicaid dependent; more than half are minorities; and the majority have multiple, additional chronic medical conditions that complicate care and that must be carefully managed.

Despite the challenges of caring for patients with such complex medical needs, the U.S. kidney care community has made important strides in improving outcomes and efficiencies and helping these Americans live longer, healthier, and more productive lives. For example, the proportion of patients receiving adequate dialysis remains high.  More patients have an AV fistula (the preferred way to access the bloodstream) than ever before. Nutritional status among patients is improving.  Overall mortality rates are improving.  And kidney care providers are making these strides efficiently and cost-effectively despite some of the narrowest margins in Medicare. While providers have thus far learned to “do more with less,” the prospect of additional funding cuts resulting from sequestration and other deficit reduction efforts threatens to undermine the measurable progress made by the kidney care community in recent decades.

The past several years have brought serious challenges for kidney care providers. In 2011, Medicare introduced a new payment system designed to encourage care efficiencies while also ensuring quality. This new system, which our community supported as a means to improve outcomes and reduce the cost of care, brought with it payment cuts of 2 percent. Since then, however, Congress has enacted additional cuts. Specifically, earlier this year, Congress enacted cuts that the Congressional Budget Office estimates will total $4.9 billion at a time when dialysis providers are still implementing a challenging new payment system. These most recent cuts are particularly worrisome, since they represent 17.5 percent of all of the health care spending reductions enacted in the legislation, while the ESRD program accounts for just over 7 percent of all Medicare expenditures. Now we face an additional 2 percent cut stemming from congressional deficit reduction actions – through sequestration. Combined, these cuts have the potential to be devastating.  
Repeated Medicare cuts will make providing care to this unique and vulnerable group of patients more challenging than it has been during the 40 year life of the ESRD benefit.

There is also very little margin available to sustain a 2 percent cut.  MedPAC, the independent blue ribbon panel that advises Congress on the Medicare program, projects that dialysis facility margins for 2012 will be 2.7 percent. This projection, however, does not take into account recent congressionally mandated cuts, which will severely reduce, if not eliminate, the Medicare margin, putting this essential program in very dangerous waters. Additionally, during its January meeting, MedPAC stated that the 2014 payment rate should be held at the 2013 level.
 
Forty years ago, members of Congress recognized the gravity of kidney failure and took the important step of ensuring that Americans with this life threatening disease, regardless of age, could depend on Medicare for treatment. Today, the necessity of dialysis therapy is no less important. We urge Members of Congress to stand behind Medicare's four decades long commitment to individuals with kidney failure and safeguard this lifesaving benefit.
 
Kuerbitz is chairman of Kidney Care Partners
 
Kidney Care Partners was founded in May of 2003, as a coalition of patient advocates, dialysis professionals, researchers, care providers and manufacturers dedicated to working together to improve quality of care for individuals with Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD).

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