By Congresswoman Allyson Y. Schwartz and Dr. Elena Rios
The recent coronavirus outbreak has millions of Americans thinking carefully about their health and wellness. For the 37 million of our friends and neighbors battling chronic kidney disease, however, health care risks that the rest of us often take for granted are never far from their mind.
Every year, 124,000 patients with kidney disease see their condition progress to end-stage renal disease (ESRD), also known as kidney failure and will require dialysis at least three times per week to survive.
Hannah, an ESRD patient in Henrico, Virginia, describes dialysis as “the most painful thing, physically and emotionally, I’ve had to endure.”
As a physician who represents medical providers in the Hispanic community – a demographic disproportionately impacted by kidney disease (Rios) – and a former lawmaker who worked to reduce the uninsured rate and improve quality of care (Schwartz), we know that stories like Hannah’s are all too common.
These individuals are looking to us to be their advocate and to join them in the cause of working toward a day when the burden of kidney disease is lifted and ESRD can claim precious lives no more.
In 2016, Congress took an important step in this direction with the bipartisan passage of the 21st Century Cures Act, making a $6.3 billion investment in medical innovations that can bring healing to the most devastating of diseases.
Included in the bill was a provision expanding ESRD patients’ options for Medicare coverage. Previous law prohibited these patients from becoming new enrollees in Medicare Advantage – the managed-care option in Medicare where 24.4 million Americans receive coverage – the Cures law removed this barrier.
As of January 2021, ESRD patients will have the choice to enroll in Medicare Advantage. For many patients, this opportunity brings hope of a better way to manage their condition.
Medicare Advantage offers an annual limit on beneficiaries’ out-of-pocket expenses – leading to savings of roughly $1,600 a year compared to Traditional Medicare – and reports a 33 percent lower rate of emergency room visits among those with chronic conditions. In a study involving a clinically complex cohort of patients with diabetes, hypertension and cardiac disease, conditions associated with ESRD, Medicare Advantage beneficiaries had a 73 percent lower rate of serious complications than those in Traditional Medicare.
This is promising news for patients, but a looming hurdle remains.
As plans and providers anticipate a switch for some ESRD patients to Medicare Advantage next year, an independent study warns that payment from the government to Medicare Advantage for ESRD patients in highly populated regions “may be significantly below actual patient costs.”
Patients with kidney failure have unique and complex health care needs, leading to yearly costs to the Medicare system of $90,000 per patient for those on dialysis. A failure to give Medicare Advantage the tools to meet these needs makes hurts patients and would cause particular harm to Hispanic and African American communities, which comprise an outsized share of the ESRD population.
Stakeholders ranging from the National Black Nurses Association, to Population Health Alliance, to Consumer Action have joined the effort to protect patients by pushing regulators to address this inequity.
Right now, the Centers for Medicare and Medicaid Services is finalizing plans for its annual rate announcement and proposed rule – vehicles through which the administration can make any number of payment and policy changes to Medicare Advantage.
This process is the agency’s opportunity to stand on the side of ESRD patients by updating its payment methodology for these beneficiaries to ensure a successful transition of care for those with ESRD.
While we strive for more permanent solutions to end the harm of kidney disease once and for all, there’s no time like right now – National Kidney Month – for policymakers to stand up and protect ESRD patients’ health care.
Allyson Y. Schwartz is the President and CEO of the Better Medicare Alliance. She represented Pennsylvania in the U.S. House of Representatives from 2005 to 2015.
Elena Rios, MD, MSPH is the president and CEO of the National Hispanic Medical Association.