There’s been much discussion in the media and online over the course of the last few weeks about the potential cuts to dialysis and the motivations of those against these cuts. As the nation’s foremost advocate for kidney patients, NKF urges lawmakers and the public to focus on the impact these cuts would have on the health and lives of hundreds of thousands of patients. This is truly the only issue.
Cutting payment to a program that over 350,000 Medicare beneficiaries rely on will hurt vulnerable patients and families who are already coping with the challenges of living with a chronic illness. These cuts will likely result in unintended consequences that disrupt dialysis patient access to quality care—now and in the future.
Most dialysis profits do not come from treating Medicare patients, so it is not accurate to assume that these companies are making lots of money at taxpayers’ expense. On average, dialysis facilities make about a 3-4 percent profit for treating Medicare patients. If Medicare payment for dialysis is cut by 9.4%, it is highly likely that facilities operating at a significant loss will have to close, leaving patients to find new units that may be a distance from their homes. Many patients have no means of transportation and such a situation would cause great hardship.
These cuts will also strain a staffing situation that is already difficult. It may become necessary to freeze the hiring of staff in the units which would mean less face time for patients with the nurses, social workers, and dietitians that are so important to their health and well being. Additionally, dialysis units may be forced to eliminate any extra benefits that improve quality care, but are not reimbursable. One such service is patient education that goes beyond Medicare’s requirements. This education is hardly a luxury for people who need to understand complex information about various treatment options, diet requirements and medication regimens.
These proposed cuts will cause many facilities to lose money treating Medicare patients. Providers will look for ways to mitigate that loss and those decisions are likely to harm some patients’ access to quality care.
NKF does not want to see patient care put at risk and as a result, we are urging the Center for Medicare and Medicaid (CMS) to appropriately cover the costs of providing dialysis treatment to Medicare patients, which may require reworking the entire payment system instead of just cutting down on the drug portion.
Please continue to check our Advocacy in Action blog for regular updates.
Advocacy in Action 
I am a past dialysis patient for 4.5 years. I received a transplant on March 25th 2013. For the last 2 years I have been a patient Advocate for the National Kidney Foundation of Florida. I have many patients that contact me on a weekly basis because they have questions about their disease, have lost access to life saving drugs and a myriad of other problems both physical and mental.
CMS and Congress should investigate the Immune suppressant drug bill and calculate the savings that would be realized by extending patient needed drugs for the life of the organ instead of killing an organ they paid to dialyze and then transplant.
If Medicare goes through with the 9.5 % cut they will save $60 per week per patient. If that cut effects patient care, which it will, there will be a greater percentage of hospitalizations per patient. This will cost Medicare significantly more than they save. Are we wrong in wanting our leaders to be able to do the math and stop reacting to short term fixes and concentrate their efforts on long term savings.
Please help stop the insanity!
Joseph Karan Patient Advocate
I use to be on dialysis and received a transplant 3 years ago. Having been there I know how important all of it is, to cut funding for any of this would be devastating for many, Those who are in charge and want to make the cuts obviously have never had the need for dialysis or have had to experience anything that has to go along with it. Well maybe they should , then I bet the story would change.
Who do we need to write or call to voice our concern about this issue ?????Thanks, Lewiss@Pineland.net
Hi Steven,
You can contact your Senators and Representative through our Take Action network
Thank you!
Erin Kahle
NKF Constituent Services Director
My husband and I were recent home hemodialysis trainees at a local center. We worked with an amazing nurse as we we prepared to begin treatments at home. We worry that there will be cuts to the payments for such invaluable training. We are also concerned about any cuts in payments for the monthly in-center lab work and physician clinics that we attend.
My patients choose between food and medicine daily. DON’T MAKE IT WORSE!
THE 3 DISEASE I HAVE IS JUST AS MUCH IN JEPPORDY MY POST TREATMENT WAS CUT BY A CRITICAL2 WEEKS AT A DANGER TO MY RECOVERY ON MY OWN AS I AM NOT UNDER DAILY SERVAILANCE AS I WAS IN THEAROPY THIS COULD NOT HAVE HAPPENED WITH OBAMA CARE I WAS IN AND OUT OF HOSPITAL 3 TIMES SINCE CHRISTMAS AND SEEN SO MUCH WASTE AND PADDING O F BILLS IT MADE ME EVEN SICKER,EXAMPLE $2 AND 5O CENTS FOR 1 BABY CHEWIBLE ASPERIN 60 PERCOCET PAIN TABLETS WICH I NEVER RECIEVED ALL OF>>>>>.A NECK BRACE I DID NOT NEED. THIS IS SOME OF THE THEFT OBAMA CARE WILL STOP .
Today I received my monthly billing notice from Medicare, the facility charged $44,734.75 for the month of June, Medicare paid $4,126.37 my sub. paid $582.25, why is there such a difference? Was the facility over charging to begin with? Perhaps this is a reason why the government has dialysis facillities under observation.
Hi Gloria,
This is a great question and an issue that is a hot topic now and very complex. Here is the short answer. Most healthcare providers (not just dialysis providers, but hospitals and other clinics too) determine what price they will charge for different services they provide. How the provider reaches the price is largely a mystery to the public. However, what they charge is rarely (if ever) what an insurance company or Medicare actually pays. Medicare has a dollar amount that they calculate to determine how much they should pay for services and it is always much less than what the provider charges. Patients do not have to make up the difference they only have to pay the 20% coinsurance on the dollar amount that Medicare sets. In your case it sounds like that’s the $582.25 that for many patients is paid by a secondary insurer.
To be consistent in all of their billing, the provider bills Medicare and all other insurance companies (and the uninsured patients) the same price even though they know they will not receive that in payment. For patients with private insurance, the healthcare provider receives payment based on what they have negotiated with the insurance companies in their network. This amount varies by insurance company and is typically much higher than Medicare payments. It gets a lot more complex from here, but there is actually a very good article that was published in TIME magazine a few months ago that talks about how this issue of healthcare provider charges and much of it also applies to dialysis. It’s a very interesting article and personally something I think everyone should know about it. I encourage you to read it. Here is the link http://content.time.com/time/magazine/article/0,9171,2136864,00.html
If you ever have more questions I’m happy to answer them and you can email me at nkfadvocacy@kidney.org.
Thank you,
Tonya Saffer
Senior Federal Health Policy Director
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