Inadequate Medicare Funding Causing Problems in Dialysis Facilities

At Senator Charles Grassley's (R IA) request the General Accounting Office (GAO) released a report entitled, "Dialysis Facility Problems Remain in Ensuring Compliance with Medicare Quality Standards, which found that overall dialysis care was improving. However, they did find staffing shortages and other problems which dialysis providers believe can be attributed to inadequate Medicare reimbursement.

Larry C. Buckelew, CEO of Gambro Healthcare and Chairman of the Renal Leadership Council (RLC), the leading association of dialysis providers, said, "It is important to recognize that renal care, in which an individual's blood is artificially cleaned, is a life sustaining method of care for 300,000 Americans with kidney failure in this country. He also noted that, " the dialysis provider industry has developed dramatically over the past thirty five years both in terms of professional patient care, and more importantly in terms of improved patient outcomes." Most dialysis providers publish patient outcome data as a matter of public record.

Mr. Buckelew said, "Members of the Renal Leadership Council are committed to advancing the quality outcomes for the patients they treat under the auspices of the leading nephrologists in this country." "Appropriate doses of dialysis are now provided to 94% of patients compared to less than 75% a few years ago and anemia management has also improved, he said. "However, Mr. Buckelew stated, that while Medicare pays on average for 75% of care in dialysis facilities, members of the RLC believe that Medicare reimbursement does not represent the true cost of dialysis care." "In fact, he said, many of the problems the GAO report finds can be directly attributable to inadequate Medicare reimbursement." In the past twelve years, Medicare reimbursement for dialysis increased by only 3.6%. "As a result, at this time, Mr. Buckelew stated, "Medicare reimbursement is inadequate to allow the continued advancement of high quality outcomes, pay for new technologies and is clearly inadequate to recruit enough nurses and healthcare workers to work in the dialysis unit"

For example, the GAO reports staffing inadequacies. Mr. Buckelew points out, "because dialysis providers are the only Medicare provider without an annual inflation mechanism, we cannot compete for scarce nurses and other health workers with hospitals and other health care providers who have built-in inflation reimbursement increases." The RLC has urged the Congress to enact Medicare dialysis payment reform by adding an annual inflation formula to the current dialysis reimbursement. At this time the RLC is waiting to find out what Congress will recommend in terms of Medicare inflation increases for dialysis facilities over the next few years.

In response to the GAO's findings that 16% of patients are receiving inadequate care, Dr. Raymond Hakim, Chief Medical Office of Renal Care Group, a RLC company, and Chairman of Kidney Care Partners, a coalition of 22 renal related organizations, said, "that this is in large part due to the fact that a quarter or more of the patients each year are new to dialysis, have on average three other major co-morbidities and therefore companies have to work very hard to provide the care needed to improve their quality outcomes." Dr. Hakim went on to say, "because of the large number of uninsured Americans, particularly African Americans, and because kidney disease tends to be a "silent disease" many patients are referred to a dialysis facility without adequate medical attention or preparation." "As a result dialysis health care workers have to work hard as a team to improve patients' health outcomes as soon as they get to the dialysis unit."

Limitations on Medicare reimbursement and coverage rules by the Centers for Medicare and Medicaid Services for an anemia management drug also are responsible for the GAO's finding that some patients' anemia is not managed as well as possible, according to Dr Hakim. Lastly, Dr Hakim said, "There is no recognition in Medicare's reimbursement for dialysis centers to use improved technology to reduce error rates and improve outcomes. The Renal Leadership Council has continuously urged Medicare to cover new technologies and nutritional supplements so that providers can continue to improve care."

About the Renal Leadership Council
The Renal Leadership Council is an association representing the interests of renal dialysis providers. The RLC members provides renal replacement therapy services in over 1,350 dialysis facilities in 42 states and the District of Columbia to approximately 110,000 individuals with End Stage Renal Disease. ESRD patients receive dialysis treatments in RLC member free- standing and hospital-based centers that are located in urban and rural areas of the country. The association was formed to represent the interests of dialysis providers in the development and implementation of public policy and to serve as a resource for Federal policy makers on national End Stage Renal Disease issues.

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