By Eric J. Edwards
Billed as one of the biggest changes to dialysis in decades, the Centers for Medicare & Medicaid Services’ (CMS) new bundled payment structure for dialysis services, also referred to as “the bundle”, was designed to streamline the way dialysis facilities and services are reimbursed. This new payment structure, which allows the cost associated with dialysis treatment, labs, medicines, and supplies to be included in a bundled payment, became effective January 1, 2011. As is often the case with change, there is much anxiety and anticipation as dialysis facilities, suppliers, laboratories, pharmaceutical companies and, most importantly, the patients brace themselves for the impact the bundle will have on their dialysis care.
The medical benefits provided to end-stage renal disease (ESRD) patients by CMS is, without question, greatly appreciated. There is no doubt that a large percentage of ESRD patients rely on this coverage to help them sustain their lives. Many of us would not be able to afford this life-saving kidney replacement therapy; it is our life support. Unfortunately, until there is a cure or more preventative measures begin to take effect, the number of people with ESRD will continue to rise, increasing the burden on CMS to cover dialysis patients’ treatment cost. Because of this, most dialysis patients do understand CMS’ need to reign in the cost associated with such treatments, but patients have also expressed concerns that the change to the payment system might be to their detriment.
While I cannot speak for all ESRD patients, I believe all of us welcome any changes that promote CMS’ continued coverage of dialysis services for ESRD patients for years to come or until they find a cure. However, if such changes will restrict access to care; affect facilities’ ability to hire, recruit, train, and retain highly skilled staff; or limit our choices in treatments and medicines that we feel work best for us and improve our quality of life, these effects would be a major concern for dialysis patients. Whether payment for dialysis services are delivered separately or bundled in a single payment is not high on the list of concerns for many patients. Dialysis patients’ top priority is to make sure that we can continue to receive quality care in order to have a higher quality of life.
For example, it is extremely important for ESRD patients to take the medications that work best for them. With the inclusion of certain medicines in the bundle, many patients are concerned about the availability of the medications that they have found to be most effective in treating their conditions. Many are asking how this new payment structure will affect access to those medicines that patients have come to rely on. Additionally, the new payment structure has the potential to reduce innovation in the drug market. How much of an incentive will drug makers have to create new and more effective medications to improve patients’ quality of life when providers have the incentive to prescribe cheaper medications to maximize their return from the bundle?
From my perspective, as an experienced dialysis patient (11 years on hemodialysis), a more effective way for CMS and dialysis facilities to lower cost while improving quality, is to make use of their most valuable resource, the patient. If patients are educated and well informed about their condition, they will make better and healthier choices, which will lead to improved outcomes. When patients are encouraged to be active participants in the management of their condition and included in decisions regarding their treatment, they are more likely to comply and adhere to their prescribed treatment plan. These, along with other preventative measures that slow the progression of chronic kidney disease (CKD) in patients in earlier stages, will not only lower cost and improve quality of care, but also decrease the prevalence of kidney disease and kidney failure and improve the mortality of ESRD patients.
While many organizations and individuals dedicated to improving the quality of care and quality of life for dialysis patients have done what they can to raise awareness and educate patients and their families about the new ESRD bundle payment system, unfortunately, there are still many people who are unaware of this change. Even more unfortunate, they are unaware of how this change could potentially impact their dialysis care.
In order to help dialysis patients better understand the new bundled payment for dialysis services under Medicare that began in January 2011 and how it may affect their care, Dialysis Patient Citizens (DPC) has introduced a new Dialysis Patients’ Guide to the Medicare End Stage Renal Disease (ESRD) Bundle, available for free download via its website, www.dialysispatients.org. The resource provides easy-to-understand, readily available information to answer the questions patients may have about this new payment structure.
Edwards is a member of the Dialysis Patient Citizens Board of Directors.
