Dialysis patients’ access to care is being threatened

Terry Foust Litchfield
3 min readAug 9, 2022

There is a healthcare access crisis in this country due to consolidation of healthcare facilities, which is being exacerbated by a workforce shortage and the lingering effects of COVID-19.

The situation will only become more dire with a new proposal from the the Centers for Medicare & Medicaid Services that makes further reductions to the Medicare Physician Fee Schedule (MPFS) and translates to major cuts to specialty care providers in office-based settings.

The proposed reimbursement reductions are another blow to patients who’ve endured severe cuts over the last several years, including clinical labor cuts of over 20% in 2022, which are being phased in through 2025. Since 2006, there have been regular cuts to office-based specialists of around 30% on average. The pandemic and high inflation rates have only made these cuts more untenable.

These continuous cuts will force office-based specialty care providers to shut down or cut staff due to too-low reimbursement levels, restricting access to care for the most vulnerable patients. Patients who rely on their local clinics for life-saving care may be left without any options.

As a patient advocate and member of the Dialysis Vascular Access Coalition, I’m joining healthcare providers and advocates from around the country in informing the public about the damage that the latest proposed cuts will do to people who are already suffering.

A coalition of 22 national medical organizations, representing a broad range of specialty providers who care for Medicare beneficiaries, have sent a letter to congressional leaders asking them to roll back the proposed reimbursement reductions in the MPFS.

Community-based healthcare facilities are already closing at an alarming rate, and more cuts in reimbursement will only make it worse. The proposed MPFS would force 8% cuts to vascular access services in 2023. Even where facilities survive, higher prices can force patients to switch to a hospital setting for care, which can be an added burden at a time when patients need and deserve ease in receiving treatment.

Hospital settings can also lead to worse outcomes for dialysis patients. Patients receiving treatment in a hospital are more likely to receive a catheter to access their bloodstream and connect a dialysis machine, rather than a fistula, which is the best standard of care. Catheters have higher rates of infection, clotting and hospitalization. Additionally, unlike specialty clinics, hospitals treat a wide range of infectious illnesses that dialysis patients cannot afford to be exposed to.

Congress must hear the voice of kidney disease patients at a time when their treatment options are dwindling and their right to care is being threatened. Office-based specialty facilities are clearly the best choice for patient outcomes and quality of life and are necessary for equitable access to treatment. I urge our leaders in Washington to stand up for their constituents’ healthcare and stop the proposed reimbursement reductions in the MPFS.



Terry Foust Litchfield

Terry Foust Litchfield spent many years in the healthcare industry as a patient advocate.