Dialysis Cost Questions, Challenges & Opportunities

Kidney Dialysis Costs

From nephrologynews.com, by Mark E. Neumann

CMS retains 12% cut in drug payments for ESRD care, approves new QIP measures

The Centers for Medicare and Medicaid Services issued its much-anticipated final rule Nov. 22 that updates 2014 payment rates for dialysis facilities paid under the end-stage renal disease Prospective Payment System (PPS). The agency also approved final changes to the ESRD Quality Incentive Program for performance year 2014, which will impact dialysis clinic payments in 2016.

Despite more than 1,000 comments protesting the proposed cut by the dialysis industry, patients, renal association groups, and even members of Congress, the agency decided to keep a 12% reduction in the drug utilization adjustment to the base rate, but implement it over a three- to four-year transition period.

(Where Medicare and the ESRD Program are headed)

CMS released a proposed rule in July that called for a 12% reduction in payments for injectable drugs based on a 30%+ drop in utilization––primarily in the prescribing of anemia drugs––from 2007 to 2012. The agency proposed to temper the cut with a 2.6% payment increase for 2014 based on the annual Medicare market basket review of costs of providing care to dialysis patients.

Congress required CMS to implement a payment reduction as part of the American Taxpayer Relief Act passed by Congress in 2012, but Congress left it up to the agency to determine the amount of the cut.

CMS said it would implement the first portion of the cut in 2014––a 3.3% reduction to the drug payment adjustment––but dialysis clinics won’t see a change in the overall payment for patients for 2014 and 2015 because of other offsets, the agency said.

The cuts will still have an impact on the bottom line for dialysis clinics, said Kidney Care Council and Kidney Care Partners in prepared statements released on Friday in response to the final rule. “Today’s Medicare ruling substantially reduces funding needed for patient care and interferes with the ability of our physicians, nurses, and clinical teams to do the very best for their patients,” said KCC chairman Tom Weinberg. Ultimately, the payment cut of $29.93 per dialysis treatment “contradicts the unified voice of patients, clinicians, providers, facilities, and members of Congress to correct the total amount of the reduction” originally proposed in July, said Weinberg. “Phasing in a cut of this magnitude only delays the harm.” [Read more]

From MedPageToday.com, By David Pittman, Washington Correspondent, MedPage Today

CMS Boosts Pay for Home Dialysis Training

WASHINGTON -- Medicare payments to dialysis facilities will remain flat next year, the Centers for Medicare and Medicaid Services (CMS) announced late Friday, almost 4 months after threatening a 9.4% cut.

The agency, however, will increase by 50% what it pays providers to train patients to do dialysis at home, much to the delight of home dialysis advocates. CMS increased by $16.72 the reimbursement per training session, to $50.16. The news came in the announcement of CMS' finalized 2014 end-stage renal disease prospective payment system.

Just 2% of patients currently administer dialysis treatments themselves at home, a method that's lower-cost than treatment in traditional centers.

"The payment for training is insufficient for the resources that are required," said Joe Turk, president of North American operations for NxStage Medical, a medical device company that focuses on end-stage renal disease. "The change CMS has made is certainly in the right direction, so we're pleased with that."

Turk, who spoke with MedPage Today in a phone interview, said few facilities offer training for home treatment -- just one in five. "One of the reasons why that's the case is that reimbursement for the training has been insufficient," he said.

Turk noted a study from the Journal of the American Society of Nephrology last year which found mortality dropped for patients receiving hemodialysis at home as opposed to an inpatient setting. He added most patients and physicians would opt for home treatment if they had the choice.

The training takes about 4 to 5 hours a day, 5 days a week, for 3 to 4 weeks, according to Kathe Lebeau, director of patient services and public policy at Northeast Kidney in Albany, N.Y. [Read more]

From OttawaCitizen.com, a blog posted by David Reeveley

Water rebates for dialysis patients to continue

City staff recommend continuing a grant program for people who use home dialysis machines. This was set up in 2007 for the benefit of a fairly small number of people who are on kidney dialysis but don’t have to go to hospital for the treatment. Something I didn’t know before the program was proposed is that dialysis uses a stunning amount of water, a cost that would be absorbed by a hospital if you were getting dialysis there but that can be a significant expense for someone getting it at home. An average of about $400 worth of water a year for each of the 16 or 17 people enrolled in the grant program over the last few years.

It costs the city little, on the order of $7,000 a year, but probably helps save a lot more than that in medical costs, so no wonder they’re recommending renewing the program, in a report to next week’s meeting of city council’s finance committee.

I’m struck by how interrelated so many things our governments do are. The health system sends dialysis patients home, which is good, but that creates unexpected burdens on their water bills, so the city government that supplies water gives them rebates.

Dialysis Treatments

From RenalBusiness.com

CERTAIN MEASURES CAN HELP PREDICT OLDER DIALYSIS PATIENTS' PROGNOSES

WASHINGTON—Simple measures of the severity of an older kidney failure patient’s illness when starting dialysis—such as whether dialysis was initiated in an inpatient setting, the length of the patient’s hospital stay, and the use of other life-sustaining procedures—can convey meaningful information about the patient’s prognosis, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The information can help guide physicians as they determine the best care for patients on dialysis.

Little is known about the circumstances under which older adults with kidney failure initiate dialysis or about how these circumstances might affect patients’ outcomes. To investigate, Susan Wong, MD, University of Washington, Seattle, and her colleagues analyzed national registry data pertaining to 416,657 Medicare beneficiaries aged 67 years and older who initiated chronic dialysis between January 1995 and December 2008. The researchers looked at the relationship between health care intensity around the time of dialysis initiation and subsequent aspects of patients’ health.

“Our research sought to provide important information on patients’ anticipated illness trajectory that could assist providers and patients in formulating treatment decisions and setting realistic expectations for the future,” said Wong.

Among the major findings:
Most patients (64.5 percent) initiated dialysis in the hospital, including 36.6 percent who were hospitalized for two or more weeks and 7.4 percent who underwent one or more intensive procedures, including mechanical ventilation, feeding tube placement, and CPR. Also, the proportion of patients initiating chronic dialysis in the inpatient setting has been rising in recent years.
Compared with patients who initiated dialysis in the outpatient setting, those who received the highest intensity of care at dialysis initiation (those who were hospitalized for two or more weeks and received at least one intensive procedure) had shorter survival times (median 0.7 vs 2.1 years), spent a greater percentage of remaining follow-up time in the hospital (median 22.9 percent vs 3.1 percent), were more likely to undergo subsequent intensive procedures (44.9 percent vs 26.0 percent), and were less likely to have discontinued dialysis before death (19.1 percent vs 26.2 percent).

The findings indicate that most older adults initiate chronic dialysis in the hospital, and those who have a prolonged hospital stay and receive other forms of life support around the time of dialysis initiation have limited survival and more intensive use of subsequent healthcare. [Read more]

From The New York Times, By JUDITH GRAHAM

Dialysis Raises Hard Questions for Older Patients

The population of people on dialysis is graying; adults aged 75 and older are the fastest growing group beginning this treatment. But often doctors don’t answer their key question: “How long can I expect to live?”

Researchers at Tufts University and the University of New Mexico underscored the disconnect in a recent review. Ninety-five percent of patients said they and their families want to be given information about life expectancy, the authors noted. But a 2010 survey cited in the study found that 90 percent of patients had never discussed the issue with their nephrologists.

The researchers called for doctors to explain prognosis to patients and undertake shared decision-making, assessing the benefits and burdens of treatment in light of a person’s values. That recommendation has also been adopted by the Renal Physicians Association and the American Society of Nephrology. But the advice is widely ignored in practice.

I interviewed several experts and reviewed almost two dozen scientific reports for some answers about the prognosis for older adults on dialysis.
Q.

What is known about life expectancy among older dialysis patients?
A.

Older people on dialysis have a significantly shortened life expectancy, compared with peers in their age group. This is especially true when they have multiple illnesses: up to one-third of older adults with severe kidney disease have four or more other ailments, such as diabetes, hypertension, heart disease or dementia. [Read more]

From The Almagest.com

Testing technique could lengthen lifespan of dialysis patients

New approach spots deadly hormone imbalances in end-stage kidney disease patients

A new testing method can better detect potentially fatal hormone imbalances in patients with end-stage kidney disease, according to a recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

At the end of 2009, more than 871,000 Americans were being treated for end-stage renal disease, according to the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). These patients require dialysis or kidney transplants to stay alive. About 10 to 20 percent of patients with chronic kidney disease stage 5, or end-stage renal disease, die each year.

One key factor that contributes to the risk of death in this population is levels of parathyroid hormone, the hormone that makes calcium available in the blood for important body functions. When parathyroid hormone levels are too low or too high, it raises the mortality risk for patients with end-stage renal disease. [Read more]

From DDDMag.com, an advertisement

FDA Approves Velphoro for Kidney Disease Patients

Velphoro (sucroferric oxyhydroxide) has received U.S. Food and Drug Administration (FDA) approval for the control of serum phosphorus levels in patients with Chronic Kidney Disease (CKD) on dialysis. Velphoro will be launched in the United States by Fresenius Medical Care North America in 2014.

Velphoro (previously known as PA21) is an iron-based, calcium-free, chewable phosphate binder. Approval in the United States was based on a pivotal Phase 3 study, which met its primary and secondary endpoints. The study demonstrated that Velphoro successfully controls hyperphosphatemia with fewer pills than sevelamer carbonate, the current standard of care in patients with CKD on dialysis. The average daily dose to control hyperphosphatemia was 3.3 pills per day after 52 weeks. [Read more]

From TheTownTalk, Alexandria, VA, by Leigh Guidry

Home dialysis improving life for Alexandria family

An Alexandria couple is thankful for more time together now with the ability to perform dialysis treatments at home.

Jack Tomlin was diagnosed as a teenager with a chronic kidney condition in which large cysts develop on his kidneys and affect their functioning.

It’s a genetic disease he inherited from his father, who received two kidney transplants. Tomlin has been on the transplant list almost two years.

He requires hemodialysis to remove waste from his blood and began treatments in July, first in a hospital and then for six months at a local clinic.

The rigid schedule of four-hour treatments three times a week had him seeing more of the clinic than home. But that changed with the addition of a home hemodialysis machine.

“It’s changed our life dramatically,” Tomlin said. “One, I’m in complete control of my treatment.”

He and wife Patty set up and clean the machine each treatment, allowing them flexibility to set their own schedule and change it when something comes up — like Thanksgiving lunch at Tomlin’s kids’ school. [Read more]

From WickedLocal.com, Brookline, MA

Home dialysis program earns honors for Brookline residents
Brookline — A dialysis program staffed by two Brookline residents has won a national award.

On Oct. 27, Dialysis Clinic Inc. (DCI, http://dciinc.org/) announced that DCI Ball Square, in Somerville, had won DCI’s 2013 Darwin Peterson Award for its home dialysis program. This annual award goes to the home dialysis program with the highest overall quality throughout DCI. The Somerville program is regional, serving patients from throughout Eastern Massachusetts, and is one of the busiest home dialysis programs in greater Boston.

Lynda Parke, RD, and Eliza Vanderstar MSW, JD, are the dietitian and social worker for the program. Both are residents of Brookline.

Parke, a native of Ireland, has worked in dialysis for 18 years. Vanderstar, who received the 2006 Outstanding Nephrology Social Worker Award from the regional National Kidney Foundation affiliate for her work with kidney patients at Beth Israel Deaconess Medical Center, has been with DCI since 2006.

Dialysis Treatment Centers

From ModBee, Modesto, CA, by BY J.N. SBRANTI

$4.6 million kidney dialysis center on track to become Modesto business park’s first building

MODESTO — The first building in the long-planned Bridges Business Park next to the Kaiser Permanente medical center is nearing completion.

The $3.6 million structure is about finished, and an estimated $1 million in interior work is planned to turn the 11,500-square-foot building into an outpatient dialysis center for those with kidney problems.

The business park, at Dale Road and Kiernan Avenue, was annexed into Modesto along with Kaiser in 2004. But about the time the property was ready for construction, the recession hit.

Park developer Ronald Malik is optimistic about attracting new companies there, now that the economy has improved.

“We have an enormous amount of interest,” Malik said about prospective businesses. “People are evaluating the market … and having a billion-dollar anchor in Kaiser is very helpful.” [Read more]

From Times of India, by Janani Sampath

Chennai lacks enough dialysis centres for kidney patients

CHENNAI: The long queues of patients with end-stage kidney problems in front of dialysis centres are a common sight almost all over the country. The Supreme Court in a recent order, based on a public interest writ petition, directed the Centre and the states to offer proper medical care for people suffering from renal diseases and kidney failure. But, little seems to have been done on the ground in this regard.

The situation in the city where two lakh patients suffer from chronic kidney problems is not very different, say health experts. Latha Kumaraswami, managing director of TANKER foundation which works to raise awareness on kidney ailments, says there is an abysmal lack of dialysis care in Chennai.



"For patients waiting for donors to undergo a kidney transplant, dialysis is the only option. There a lot of centres that have been set up recently, but still cover only 20% of the patients," she said. The equipment and its maintenance are very expensive and so the treatment cost is unaffordable to many, she added.

The city has nearly 18 dialysis units, including two corporation-run units that offer free or subsidized dialysis sessions at Rs 375 a session for people from economically backward sections. The centres become crucial given that a dialysis session at a private hospital costs Rs 800-Rs 1,900 and patients require 2-3 sessions a week. "In private hospitals the cost comes up to nearly Rs 20,000 a month," said Latha.

Though the city has 50 nephrologists in the government and private sector, there is a huge demand for dialysis centres, says TANKER foundation trustee Dr Georgi Abraham. "There is a pressing need for dialysis units in three-tier cities and towns. But considering the equipment cost, electricity and water needed for hemodialysis, the government should consider bringing in the peritoneal dialysis (home dialysis) option that is already successful in Thailand," he said. [Read more]

From Zawya.com, Jeddah, Saudi Arabia

Jeddah to have kidney treatment center soon

The Prince Abdul Majeed Center for the Treatment of Kidney Disease in Jeddah is about to be opened, said Sami Badawood, director-general of Health Affairs in Jeddah. "The equipment and medical supplies for dialysis treatment are currently being brought in," he said. The three-story center, which cost about SR28 million, has a capacity of 150 beds and can accommodate 900 patients. It includes 140 dialysis devices and provides medical, therapeutic, social and awareness services to patients with renal failure.
The center is located at King Fahd General Hospital in Jeddah, where 18 nephrology consultants, 35 resident physicians and specialists and 280 nurses work in 16 specialized clinics designed to receive and treat kidney disease patients daily. Badawood confirmed that the old center in Jeddah's Al-Baghdadiah District will be closed and its services will be directed to other health services. The center's workforce will be shifted to the new center, he added. The new center is expected to admit 30-40 patients in need of renal dialysis and other related services daily. [Read more]

From Virgin Islands Daily News, BY ALDETH LEWIN (DAILY NEWS STAFF) 

Private dialysis clinic opens on St. Thomas

ST. THOMAS - The first private hemodialysis clinic has opened on St. Thomas, offering another option for patients struggling with kidney failure.

The Caribbean Kidney Center-St. Thomas, owned by Dr. Walter Gardiner, opened Monday and currently is serving four patients while it is waiting for certification by the Centers for Medicare and Medicaid Services.

Gardiner said he has notified CMS that the clinic is in operation, and now he has to wait for them to come do an unannounced site visit and inspection.

Until the clinic is certified, he is not allowed to charge Medicaid nad Medicare for services, which is why he has limited the patient load to four for now.

"We have to treat patients so we have a record," he said.

"We hope they come soon, and once they come and we're certified, we'll open the doors to everybody." [Read more]

Kidney Transplant Debate

From The Daily Pennsylvanian, by Brenda Wang

Penn prof proposes legalizing sale of kidneys

According to estimates, nearly 100,000 people in the United States are waiting for a donation

Imagine paying off student loans by selling a kidney.

Matthew Allen, a student at the Perelman School of Medicine, and Peter Reese, an assistant professor of medicine at Penn, are calling for a reassessment of the National Organ Transplant Act of 1984, which prohibits the buying and selling of human organs for transplantation. In a recent editorial in the Clinical Journal of the American Society of Nephrology, Allen and Reese suggest that a “limited, real-world trial” of payment for kidney donations should be allowed so that researchers can assess the effects of such a policy. [Read more]

PKD Fundraising

From AllFacebook.com, by Guest writer

How Facebook Can Help Nonprofits Raise Money And Awareness

Like most nonprofits, the PKD Foundation aims to raise awareness of the issue it seeks to solve. Greater awareness leads to greater interest from scientists, politicians, and potential donors in working for a cure.

Polycystic kidney disease — a condition that has no cure — is one of the world’s most common life-threatening genetic diseases, affecting thousands in America and millions worldwide, although few people have heard of it. Working with BLiNQ Media, the PKD Foundation held a social media campaign that resulted in raising that awareness very effectively. The campaign increased interaction with foundation content by 439 percent, with total reach — the number of people exposed to our message — skyrocketing by 1,158 percent.

BLiNQ promoted the PKD Foundation’s Facebook campaign throughout March — National Kidney Month — pushing daily page posts to our existing fan base, friends of fans, and people who had expressed interest in kidney issues. BLiNQ also used its proprietary algorithm to find other people who seemed likely to engage with the PKD Foundation’s message. Because of this, our circle of influence increased, and we reached new people with our message.

The campaign resulted in 16,000 clicks on PKD promoted posts, and more than 14,000 engagement actions with PKD Foundation content. The response was remarkable. While the average click-through rate for mobile Facebook ads is no more than 1.6 percent, depending on who’s measuring, our campaign’s average CTR was 5.1 percent. [Read more]