Thread: Medicare Rationing for Kidney Dialysis

The Weekly Standard

Medicare Rationing for Kidney Dialysis

Washington (The Daily Standard) – A new proposal from Medicare has been published in the Federal Registry and it provides a window on how medical care will be delivered in the future under a government-run system. Medicare is proposing to provide a fixed budget for the medical care of dialysis patients and the details of the plan guarantee that patients will have a private company intervening in physician decisions whether to provide expensive but highly beneficial drug therapies.

The end stage kidney disease program, better known as kidney dialysis, is the one aspect of Medicare that applies to persons less than 65 years old. This quirk in the system began in the 1960s in order to help fund the expensive dialysis programs that were feasible but enormously costly on a per treatment basis. These are life-saving treatments and could not possibly be affordable to most patients. Over the years, the program has grown larger and larger because more and more patients were found to benefit from the treatment. The cost per treatment is actually about 64% of the costs 20 years ago, factored for inflation, as tremendous efficiencies have been introduced. But the program has grown to now cost 6.4% of Medicare's total budget or some $23 billion in 2006. This is because over 350,000 patients receive dialysis treatments in the United States.

One way that the system has been able to keep per treatment costs low has been the entry and domination of the industry by large, for profit, public companies like Fresenius Healthcare and Da Vita Healthcare, that can provide the capital and the integration of services to be profitable under a highly constrained cost structure. Kidney specialists are not employed by these companies but supervise care for the patient and are paid directly by Medicare for their services.

But costs continue to rise because of rising numbers of patients receiving dialysis treatments and Medicare has now decided that since drug therapy is a rising source of costs for the dialysis program, a prepayment for drug treatment will be included in a "bundled" payment for dialysis services. The "bundle" of money will go to the for-profit dialysis provider and the company will have to buy and then dispense the medications prescribed by the independent physicians. These key medications will no longer be reimbursed under Medicare's Drug Plan, the so-called "Part D". So if the physician prescribes expensive medications compared to less costly but less effective ones, the company could and probably would lose money.

This is clearly an example of Medicare creating a system that potentially interferes with a physician's best judgment and looks to the possibility of rationing more costly medications. Dialysis unit administrators will have a strong incentive to restrain physicians prescribing the more expensive medications that will likely provide a long term benefit for patients. The particular medicines that will be most affected are those that help improve bone function over the long term in dialysis patients but have little obvious short term effects. It will take years to sort out the impact of this approach.

It is true that hospitals must pay for expensive medications required by hospitalized patients and hospitals try to influence physician utilization of these expensive medications. But hospitals use physician committees to modify utilization in an appropriate fashion. The dialysis providers in a community dialysis unit do not have the resources of a hospital to organize committees of physicians to oversee utilization. Patients in dialysis units will have no inkling whether their medication regimens are based on the best care available or on the bottom line profits of a commercial enterprise. Both the companies and the physicians are being put in a bind by the government plan.

The new approach is open to public comment at this time but this is clearly the new face of rationing. Restrict payments through providing a fixed budget for care. Welcome to the British National Health Service.

Stanley Goldfarb MD is associate dean of clinical education at the University of Pennsylvania School of Medicine and a nephrologist.

http://news.yahoo.com/s/weeklystandard/ ... eydialysis

They would be better off cutting off illegal immigrants receiving dialysis thru Medicaid.

Meanwhile, illegal aliens are not denied their fourth liver transplant under EMTLA/MedicAID.

http://michellemalkin.com/2008/04/14/li ... n-borders/

But costs continue to rise because of rising numbers of patients receiving dialysis treatments

And how many of these are here illegally? Wasn't there another post on here with an article on how that one Hispanic woman was going from hospital to hospital in Georgia getting a dialysis?

And the most insipid thing is that dialysis costs far less in Mexico. I saw a chart recently comparing renal dialysis in a number of countries (2008 figures). In Mexico the cost was about 9600 dollars per year. In the US it was 46,000. Some countries were as high as 76,000. Just about any medical expense in Latin America is a fraction of what it is here, and they are very close to having the same technology.

The American public is being robbed blind. Allowing illegal aliens to be here, sucking up our relatively expensive medical care, which just drives up the cost further for Americans, is outright stupidity.

Originally Posted by uniteasone

But costs continue to rise because of rising numbers of patients receiving dialysis treatments

And how many of these are here illegally? Wasn't there another post on here with an article on how that one Hispanic woman was going from hospital to hospital in Georgia getting a dialysis?

I remember reading that here too. There were several illegal alien patients on dialysis. Instead of cutting costs to anyone, just deport the millions of illegal aliens who are partly responsible for insurance rates going sky high.

Our dirty political majority elites don't care if we live or die if we don't bring them tax dollars.

I know that there are illegals getting dialysis at Memorial Hospital in Hollywood Florida. There are many more at Jackson Memorial in Miami. In fact that hospital and others owned by them are going broke. Between all the shooting victims who get airlifted to Ryder Trauma which is owned by Jackson, illegals or a combination of the two they are in trouble.

That is bad enough but what really got me was when a physician's assistant at Broward General told me that they do heart surgery on illegals on a regular basis. The illegals are mostly from Central America and smoking crack has cause heart damage requiring stents being put in.

They ought to just cut off medical help to the illegal aliens. Some would say that is cruel. SO WHAT! This is a cruel world..

Originally Posted by uniteasone

They ought to just cut off medical help to the illegal aliens. Some would say that is cruel. SO WHAT! This is a cruel world..

If you go to any other country and get sick you pay. I had to see a doctor back in the 80's while in Acapulco and I had to pay.