Continued Health Inequity for Dialysis Patients
A recent CDC report provides more powerful evidence of the persistent inequities that exist in our health care system for vulnerable dialysis patients. The report found that patients on dialysis were 100 times more likely to experience staph bloodstream infections, a leading cause of death for dialysis patients — with Hispanic patients experiencing an astounding 40% higher infection rate than non-hispanic white patients.
There’s no shortage of startling statistics demonstrating the continued injustices in outcomes for dialysis patients in this report. End-stage renal disease (ESRD) is four times higher in the Black population and more than two times higher in the Latino population. Black people are 33% of dialysis patients but only 12% of the U.S. population.
A major step that can be taken is to provide every patient with their best option for vascular access in dialysis, which plays a critical role in infection risk. Dialysis vascular access is easily treated outside of a hospital setting, and specialty-care providers operating in office-based settings are by far the safest option for this type of care. Dialysis access centers have been proven to have better patient satisfaction and better outcomes than hospital-based procedures.
However, we need our government’s support in correcting these inequities. Continued cuts in the Medicare Physician Fee Schedule year after year for specialty-care providers have threatened many of these dedicated access centers. One-third have closed since 2017, leaving many patients with only hospital-based care.
The devastating results of a shift to hospital-based care aren’t obvious to those who haven’t had to undergo this treatment, so it is up to us to help our lawmakers understand the unintended consequences. Patients in a hospital are more likely to receive a catheter to connect a dialysis machine, rather than a fistula, leading to worse outcomes. Fistulas are the best standard of care and provide the lowest infection risk.
The CDC report cites a study that found that staph infection risk was most strongly linked with patient vascular access type. Compared with fistula access, catheters had about six times higher risk while graft or other had around two times higher risk. Further, facility characteristics significantly tied to higher infection incidence included any hospital affiliation and not being part of a chain of dialysis centers.
Dialysis patients that are forced to turn to hospitals for care also risk being exposed to more infectious diseases, which can sometimes end in death. Plus, dialysis vascular access services in a hospital are frequently more expensive for both the patient and for Medicare.
Cuts to the Medicare Physician Fee Schedule for community-based specialty-care providers lower the quality of care for patients in ways that can be life-threatening, particularly for communities of color. Allowing patients and their providers the choice in the care for setting is a crucial piece of this puzzle.
Join us, along with the Dialysis Vascular Access Coalition, Renal Physicians Association, American Society of Nephrology and others in restoring the cuts to office-based specialists so we can help bridge the health inequality in dialysis vascular access care. Urge your elected officials in Washington to stop the continued, unsustainable reductions in the Medicare Physician Fee Schedule.
About the writer: Terry Foust Litchfield, was married to the US’ longest surviving dialysis patient, and spent many years in the healthcare industry. She serves on many patient groups such as AAKP and DPC as well as the Dialysis Vascular Access Coalition. When she retired, she started Dialysis Access Solutions, a kidney patient advocacy group that advances care for patients on dialysis needing access to vascular access services. Her patient advocacy efforts are pro bono and she can be reached at 847–651–1404. Her website is www.dialysisaccesssolutions.com.
