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To protect kidney care, stop Medicare cuts

September 23, 2018

Across Texas, we value healthy communities, affordable treatment options and patients’ power to choose their own care setting.

Unfortunately, not everyone shares these same values. Misguided policies from Washington threaten access to vital health care services that Texans living with end stage renal disease, or ESRD, need to live longer, healthier lives.

ESRD — better known as kidney failure — is one of the leading causes of death in the United States with nearly 90,000 Americans passing away annually as a result of diminished kidney function. According to the CDC, kidney disease is the ninth leading cause of death in Texas, resulting in an estimated 4,125 deaths annually.

Nonwhite kidney failure patients are especially susceptible since African-Americans and Hispanic-Americans are more likely than Caucasians to be diagnosed with kidney disease.

Over the past 15 years, there has been tremendous progress in helping patients receive safer and more effective kidney care through hemodialysis, which removes toxins and excess fluids from the blood much as a normal kidney would.

To connect the body to the dialysis machine, physicians must create an access point in the patient’s bloodstream called a vascular access procedure. Most vascular access services are provided in the nonhospital setting (i.e., doctor’s offices or ambulatory surgical centers) — as opposed to hospital outpatient departments, where patients often face delays in care and inferior outcomes.

Not only do patients overwhelmingly prefer to be treated in a specialized, vascular access focused, nonhospital setting, research shows that their health outcomes are also better when they visit local physician offices. A recent study of more than 200,000 Medicare patients shows that ESRD patients treated in an office setting exhibit 20 percent fewer infections, require 14 percent fewer hospitalizations, and have 15 percent lower mortality rates than when vascular access services are provided in a hospital setting.

With the average patient waiting three to five years on the kidney transplant list, continued access to dialysis in our communities is critical to keep kidney failure patients alive.

Despite these proven benefits, the federal Centers for Medicare and Medicaid Services, or CMS, — which runs the Medicare program for American seniors — is proposing new policies that would drastically limit ESRD patients’ ability to choose the care they prefer.

In its 2019 payment rule for patients with kidney failure, the federal agency proposed to slash Medicare reimbursement rates to vascular access services by a whopping 62 percent. The measure comes on top of a severe 39 percent cut in 2017, which caused a significant number of office closures.

Most worrisome, the cuts will force tens of thousands of seniors to travel greater distances, wait longer in hospital emergency rooms, and receive subpar vascular access care that makes the risk of infection and hospitalization more likely.

To add insult to injury, seniors will be forced to pay higher copays for the “privilege” of being treated at a hospital.

This sad situation is unacceptable.

We must tell the federal government that Texans living with kidney failure deserve so much better. For the sake of patient choice, affordability and the right to good health, I urge every member of the kidney care community to contact your members of Congress to express your concern with proposed cuts through emails and phone calls.

Together, we can reverse this shortsighted proposal so that our parents, neighbors and loved ones with kidney disease continue to get the care they need close to home.

I am grateful to one of San Antonio’s member of Congress, Will Hurd, who opposes these cuts and hope he will help lead Congress in an effort to overturn the cuts through a regulatory or legislative remedy.

Tiffany Jones-Smith is chief executive officer of the Texas Kidney Foundation.

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