Unless Congress Acts Clinical Labor Cuts Will Worsen Health Outcomes for Dialysis Patients

Terry Foust Litchfield
3 min readOct 6, 2022

As someone who has dedicated her life to advocating for dialysis patients, it was an honor to participate in the United Specialists for Patient Access virtual lobbying day on behalf of the Dialysis Vascular Access Coalition. My message to lawmakers was clear: Ongoing clinical labor cuts to office-based providers in the proposed Medicare Physician Fee Schedule will continue to destroy dialysis patients’ access to care across the United States.

I am grateful to the Wisconsin congressional delegation who took the time to speak with me and for giving me the opportunity to give dialysis patients a voice on Capitol Hill. Legislative staff from the offices of Sen. Tammy Baldwin, Sen. Ron Johnson and Rep. Mark Pocan were very engaged in our meetings and all have been very supportive of vulnerable patient issues. We talked about the issues of patients in rural areas and how much we still feel the impact of COVID in the dialysis world.

The Centers for Medicare & Medicaid Services’ proposed cuts to reimbursement levels in the Medicare Physician Fee Schedule will force many office-based specialty care providers to shut down, cutting off patients who rely on their local clinics for life-sustaining services.

I made it clear during my meetings that fixing the conversion factor cut and not the clinical labor cut would be a mistake. Policy makers need to understand that leaving the clinical labor cuts unaddressed would shatter our already fragile health system across the country. COVID has had a devastating impact on the dialysis patient population, for the first time in 50 years there has been a decline in the patient population receiving dialysis. Patients still are wary of hospitals so these free standing centers (who provide about half the vascular access care) are important community settings to keep them doing well on dialysis.

The proposed reimbursement reductions are compounded by crippling clinical labor cuts of over 20% in 2022, which are being phased in through 2025. Since 2006, there have been cuts in Physician Fee Schedule to office-based specialists of around 30% on average and nearly 40% for vascular specialists. If Congress doesn’t act to reverse this dangerous trend, we risk putting patients’ lives in jeopardy.

The devastating effect these clinical labor cuts would have the worst impact on Americans in need of dialysis when local dialysis vascular access centers are forced to close, especially those in rural areas and other underserved communities. I emphasized how important the availability of local care is to both the longevity and quality of patients’ lives. Having to travel long distances for dialysis vascular access services is a big burden on families, and it can even prevent patients from accessing care at all.

Many people who have not had to seek dialysis vascular access services don’t understand the consequences of a shift to hospital-based care. I helped them understand that office-based, specialty-care providers offer the safest means to receive these life-saving services. Patients in a hospital are more likely to receive a catheter to connect a dialysis machine, rather than a fistula, leading to worse outcomes. Catheters have higher rates of infection, clotting and hospitalization. Dialysis patients forced into hospitals risk being exposed to more infectious diseases, which can be life-threatening. On top of it all, dialysis vascular access services in a hospital can be significantly more expensive.

I also shared my personal story of caring for my husband who needed access to dialysis treatment to live and who received his vascular access care in a free standing center for the last decade he was alive. I asked them to fight alongside me for kidney disease patients and stop the proposed reimbursement reductions and reverse the untenable, continuous clinical labor cuts in the MPFS.

As I spoke to leaders in Washington, I felt privileged to carry on the legacy of my late husband Bill, who dialyzed on Capitol Hill to fight for national coverage for dialysis. I will continue to carry this message until every American has access to convenient, safe options for receiving the care they need to survive and thrive.



Terry Foust Litchfield

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