Medicare Needs Reimbursement Stability for Vascular Access
I am a dialysis patient advocate because I want to give kidney patients their voice and their choice in kidney disease treatment. I have lived through the experience of a loved one who needed access to survive. My late husband was a pioneer, best known for dialyzing along with 3 other dialysis patients on Capitol Hill to request national coverage for dialysis. When Bill died, he was the longest surviving dialysis patient in the United States with 46 years of renal replacement therapy prior to his death. It was a journey for us and an experience that taught me valuable lessons that I can share with patients and their families.
If the dialysis care continuum were functioning at peak performance, there would not be a need for my job. But the system is not working, and I need to talk to you about “access.”
For a dialysis patient, the word “access” can mean more than one thing. For example, access can refer to the means of “vascular access” to a patient’s bloodstream. Before dialysis treatment can start, physicians must first create a conduit (commonly referred to as a vascular access) to the patient’s bloodstream in order for the patient to connect to a dialysis machine. There are several methods to access the bloodstream but typically the best option is a fistula. A fistula is a permanent access in the arm that connects between an artery and a vein and allows patients to connect to a dialysis machine. Data has shown that fistulas result in lower rates of infection and hospitalization, less clotting, and lower cost than other methods like a catheter.
However, “access” also takes on a whole new meaning when vascular access centers close. Having to drive hours for dialysis vascular access services is not only inconvenient, it discourages the provision of these critical services. Peer-reviewed data shows that receiving dialysis vascular access services in a hospital means a higher likelihood of a catheter for vascular access, which in turn means worse outcomes. From a cost of care perspective, vascular access services can cost 3–5 times more in a hospital than in a freestanding center.
I love what I do because it allows me to help patients and their families improve their quality of life. Dialysis adds years to a kidney patients’ life and good vascular access adds life to those years.
Unfortunately, the problem facing many Americans in need of dialysis is that local dialysis vascular access centers are being forced to close, which is a major obstacle for Medicare beneficiaries in rural areas who are seeing their treatment options dwindle. These dialysis vascular access centers are closing due to significant reimbursement volatility under the Medicare program. For example, in 2017, the Centers for Medicare & Medicaid Services (CMS) cut reimbursement payments by 39%, forcing more than 20% of centers to close, according to a recent study. The COVID pandemic has exacerbated the situation by making hospital-provided vascular access care potentially even more dangerous.
Dialysis vascular access centers need Medicare reimbursement stability. Providing top notch dialysis vascular access care is difficult if centers are fighting every year just to stay open. We need leadership in Washington that will fight to fix the Medicare fee schedule so health care providers can give the best possible vascular access services to dialysis patients.
By Terry Foust Litchfield
Terry Foust Litchfield, married to a long-time dialysis patient, she 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 www.dialysisaccesssolutions.com.
