Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Medicare’s high cost end stage renal disease patients

Merrill Goozner
Conditions
June 11, 2011
18 Shares
Share
Tweet
Share

Anyone who thinks America has the best health care system in the world ought to take a look at its miserable record on caring for end stage renal disease patients on dialysis.

About one of every five people who go on dialysis dies in the first year here, compared to less than one in seven in Europe and one in sixteen in Japan. Even after adjusting for age, gender, race and 25 co-morbid conditions (the primary causes of kidney failure are poorly treated diabetes and hypertension), the U.S. mortality rate is one-third higher than Europe and nearly four times the Japanese rate, according to a recent analysis. The average life expectancy of Americans on dialysis is about three years.

Taxpayers pay exorbitant sums for these poor outcomes. The Centers for Medicare and Medicaid Services, which cover treatment for end-stage renal disease, even for the non-elderly, spent $24 billion on dialysis in 2007. Just one percent of Medicare beneficiaries who are on dialysis generated a whopping 5.6 percent of the agency’s bills. Moreover, the obesity epidemic guarantees that those numbers will only shoot up in the years ahead since more than 100,000 people are now entering dialysis ever year – more than the number that die from the one of the conditions that leads to kidney failure.

You would think that the nephrology community would be up in arms over these alarming statistics, or at least looking for a less expensive and hopefully more effective way of caring for these predominantly poor patients. Yet two new studies in the Archives of Internal Medicine reveal just the opposite. A small and declining number of patients receive peritoneal dialysis, an at-home alternative that generates comparable outcomes with greater patient satisfaction at 19 percent lower cost – $53,446 per year for patients on peritoneal dialysis versus $73,008 on in-clinic hemodialysis in 2007, according to one study.

And the other study showed nephrologists do a poor job of informing patients about this three-decade-old alternative. Peritoneal dialysis (PD) has declined from 14.4 percent of the dialysis population in 1995 to 7.1 percent in 2007. In an accompanying editorial, Dr. Kirsten Johansen, a nephrologist at the University of California at San Francisco, wrote:

The data available so far have led experts to conclude that low PD utilization is, at least in part, the fault of nephrologists, who are not discussing PD options with patients, possibly owing to concern about higher mortality (which the latest study shows is incorrect), inadequate training of nephrologists, nephrologists’ bias against PD, pressures to fill HD (hemodialysis) chairs, late referral to nephrologists, and other reasons.

I was intrigued by the “pressures to fill HD chairs” statement in the editorial, so I sent Dr. Johansen an email late last night. Were there any financial incentives that encouraged nephrologists associated with the for-profit dialysis clinics that discouraged use of this less costly alternative?

“Typically the dialysis clinic owners will hire a nephrologist to be medical director,” she wrote back. “This reimbursement isn’t tied to bringing in patients but the nephrologist then has an interest in the success of the clinic, and since they have to see their patients in that unit once a week to receive maximum Medicare reimbursement, it’s better to have several patients there on each shift to increase efficiency. I don’t think there is any solid data to say that this has an impact on how well nephrologists inform patients, but many have speculated about this.”

Last year, CMS added a new benefit for end-stage renal disease patients. The agency will reimburse physicians for up to six counseling sessions just before their patients are about to go on dialysis. The agency wants more people to consider the PD alternative, which involves removal and re-infusion of an abdominal cavity fluid about four times a day and can be self-administered at home. That doesn’t sound like fun, but patients consistently rank it as a  better experience than having to go to a distant clinic three times a week for four- to six-hour sessions where they are hooked up to a machine.

If half the new dialysis patients in the U.S. chose PD over HD, Medicare could save more than $5 billion a year. The additional counseling needed to get to those rates might even jump-start the long overdue conversation about why so many people do so poorly once they’re on dialysis; why so many have failing kidneys in the first place; and what preventive measures can be taken to deal with this burgeoning public health fiasco.

Merrill Goozner is a freelance writer, independent researcher and consultant who blogs at Gooznews on Health.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Securing mobile devices in healthcare

June 11, 2011 Kevin 2
…
Next

MKSAP: 50-year-old woman with advanced multiple myeloma

June 11, 2011 Kevin 3
…

Tagged as: Medicare, Patients, Specialist

Post navigation

< Previous Post
Securing mobile devices in healthcare
Next Post >
MKSAP: 50-year-old woman with advanced multiple myeloma

More by Merrill Goozner

  • a desk with keyboard and ipad with the kevinmd logo

    Curbing Medicare costs: Are seniors or the government responsible?

    Merrill Goozner
  • a desk with keyboard and ipad with the kevinmd logo

    Will health reform survive the Supreme Court?

    Merrill Goozner
  • a desk with keyboard and ipad with the kevinmd logo

    A look behind the growing cost of cancer drugs

    Merrill Goozner

More in Conditions

  • Epigenetics and our inheritance to future generations

    Vishruth Nagam
  • COVID-19 unleashed an ongoing crisis of delirium in hospitals

    Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD
  • Emergency care nightmare: the urgent need for experienced nurses

    Rachel Basham, RN, CCRN
  • Debating the role of psychiatric assessments in medical decisions

    Christian Youssef & Francisco M. Torres, MD
  • 5 things to know about weight from a bariatric surgeon

    Maria Iliakova, MD
  • Physician autonomy and patient interactions in corporate health care

    Michele Luckenbaugh
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions
    • Practicing medicine with conviction

      Arthur Lazarus, MD, MBA | Physician
    • The power of memory in shaping human identity

      Emily F. Peters and Sandeep Jauhar, MD, PhD | Physician
    • How Tratak yoga reshaped my USMLE Step 2 prep

      Dr. Nikita Mehdiratta | Education
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • FDA Relents, Approves Novel Antidepressant After Many Rejections
  • OSHA Comes in for Both Praise and Harsh Criticism at House Hearing
  • New Insight Into Hyperglycemia Risk With PI3K Inhibitor for Breast Cancer
  • Oktoberfest Doctor: Not the Wurst Job You Could Have
  • Blue Shield of California Has Fix for MA Enrollees Worried About Co-Pays

Meeting Coverage

  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions
    • Practicing medicine with conviction

      Arthur Lazarus, MD, MBA | Physician
    • The power of memory in shaping human identity

      Emily F. Peters and Sandeep Jauhar, MD, PhD | Physician
    • How Tratak yoga reshaped my USMLE Step 2 prep

      Dr. Nikita Mehdiratta | Education
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Medicare’s high cost end stage renal disease patients
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...