The American Association of Kidney Patients (AAKP) expresses concern over the proposed 9.4% cut in payment for dialysis services that was released July 1 by the Centers for Medicare and Medicaid Services (CMS) as part of the proposed rule for the 2014 ESRD Prospective Payment System (PPS). These cuts, scheduled to go into effect January 1, 2014, follow several earlier reductions in payment for services to patients suffering from End Stage Renal Disease (ESRD). They also follow sequestration-related cuts implemented at the beginning of 2013.
AAKP is concerned about potential unintended consequences including the possibilities of compromised safety, and limited access to care for our members on dialysis, potentially stemming from Medicare’s proposed rule to reduce dialysis reimbursement by value based purchasing. If the rule is adopted as written, AAKP encourages its members to be mindful of these potential unintended consequences and report their occurrences to Medicare, ESRD Networks, or AAKP.
There are an estimated 20 million persons in the USA who have chronic kidney disease (CKD), most commonly the result of diabetes or hypertension. On an annual basis, approximately 116,000 (0.6%) of this pool of individual patients with CKD progress to the point where replacement kidney therapy is required to sustain life. Only a few of these will receive a kidney transplant because donor organs are very scarce, and most undergo dialysis to stay alive with a reasonable but not normal quality of life. Some patients are capable of dialyzing at home, but the rest must receive treatment three to four times a week in a local dialysis center. ESRD most frequently afflicts the elderly and those of African American and Hispanic ancestry. Life sustaining dialysis therapy is a miracle for them and many others with ESRD.
We urge patients, their families and the public to write their representatives and senators in Congress, asking them to step in and urge CMS to fully take into consideration the consequences of any proposed action on the quality of and the access to dialysis care for ESRD patients. It will be very important to carefully watch for the potential negative effects of reimbursement reductions on outcomes of care for ESRD patients as a whole, but especially for highly vulnerable populations, such as the elderly or disadvantaged.