Congress: Act now to improve access, care for individuals with kidney failure

February 29, 2016

Published by The Hill Congress Blog
February 29, 2016

In just a few short decades, our ability to treat patients with once-terminal conditions has advanced dramatically. Thirty years in practice as a nephrologist have given me a front-row seat to remarkable changes and positive advances for individuals with multiple complex health conditions, including improved patient outcomes, reduced mortality rates, and a better quality of life.

These years of progress have changed the equation from whether chronically ill patients can be treated successfully, to how we can treat them most effectively.

Without a doubt, how to improve the effectiveness of care for chronically ill individuals will be our overwhelming challenge in the decades to come. Patients with chronic conditions – like kidney disease, diabetes, and heart failure – are complex and costly to treat, since many of these individuals suffer from multiple disease conditions, see numerous specialists and take multiple medications. As patient populations continue to grow and Medicare expenditures continue to increase, patients and taxpayers alike have a stake in improving care through avoiding known expected health crises, lowering costs and preserving the integrity of the Medicare program.

Most recently, the U.S. Senate Committee on Finance has named chronic disease management a top policy priority, for which they convened a working group last year to identify reforms that can effectively improve the care delivery and quality of life of chronically sick Americans – including how to strengthen disease management, streamline care coordination, improve quality, and reduce Medicare costs.

Data indicate that Medicare Advantage plans, which provide coordinated care that is lacking in traditional fee-for-service Medicare, can be very effective in supporting positive outcomes in quality, safe and efficient healthcare.

For patients diagnosed with End-Stage Renal Disease (ESRD), or kidney failure, the coordinated care offered through Medicare Advantage plans has resulted in fewer hospital days and disease-related complications. One program, for example, resulted in a 24.8 percent reduction in inpatient admissions, a 10.3 percent reduction in ER visits and an 8.5 percent reduction in specialty visits for kidney failure patients.

Despite the positive outcomes we’ve seen among kidney failure patients enrolled in Medicare Advantage plans, individuals enrolled in fee-for-service Medicare who develop kidney failure are prohibited by law from enrolling in a Medicare Advantage plan. Under current law, if an individual has a Medicare Advantage plan when they are diagnosed with ESRD they are allowed to keep their plan. Otherwise, patients diagnosed with kidney failure have no access to the benefits provided through Medicare Advantage.

As kidney patient care providers and advocates, we feel prohibitive policies that restrict patient access to Medicare Advantage plans are discriminatory to the ESRD patient population, and have no basis in health policy.

Instead, patients with kidney disease and kidney failure should have the choice to enroll in a Medicare Advantage plan just like every other Medicare beneficiary. By doing so, these patients would have access to a proper infrastructure that has proven to improve outcomes and avoid unnecessary hospitalizations, inefficiencies, added expenses, and sometimes contradictory or redundant services or therapies. Offering our kidney disease patients the choice to enroll in Medicare Advantage plans would benefit patients, their care providers and taxpayers alike.

As far as we have come over the past 30 years, the future of health care – and of kidney care specifically – depends on our ability to evolve our care delivery system. We need to be strategic and innovative in modifying existing programs, such as Medicare Advantage, and shaping a future where care coordination models designed around the patient’s need and the avoidance of known health crises are the norm – not the exception.

I urge lawmakers to take steps to ensure all individuals have equal access to coordinated care services that support quality outcomes, improved efficiencies and a positive patient experience. Lifting restrictions on Medicare Advantage plans for kidney failure patients would do just that.

Maddux is chair of the Kidney Care Partners; chief medical officer and executive VP of Clinical and Scientific Affairs at Fresenius Medical Care.

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