Proposed Medicare policy is bad medicine, business

Cuts to reimbursement rates would mean fewer Texans get more-proven treatment

Across Texas, more than 62,000 people are living with kidney failure (also called end-stage renal disease, or ESRD). It can be a terrifying diagnosis. After all, without a kidney transplant, ESRD can lead to death. And there aren’t nearly enough donated kidneys for everyone who needs one.

Yet, thanks to modern medicine and good public policies, people suffering from kidney failure have reason to hope. Dialysis care allows a machine with an artificial kidney to keep patients alive and healthy. And AV fistulas are internal connections that allow patients’ own bodies to attach to those lifesaving machines, with relatively few complications.

Fistulas require an outpatient surgical procedure and are fundamentally important to good dialysis care. Unlike external catheters (which are also sometimes used for dialysis), fistulas last longer, are less prone to infection and clotting, and are dependable for long-term use. Medicare has deemed fistulas so important for good dialysis care that two-thirds of kidney failure patients receive fistulas, up from only 30 percent in the mid-2000s.

So, it’s incredibly troubling that policymakers in Washington, D.C., have proposed policies that slash reimbursement rates for dialysis vascular-access services. Despite the proven benefits of fistulas, the Centers for Medicare & Medicaid Services is proposing to cut reimbursement by 62 percent next year, on top of a 39 percent cut made in 2017.

Drastic cuts in 2017 have already forced significant numbers of offices where fistula procedures are done to close. Additional cuts next year will certainly impact the type of care patients in Texas expect and deserve.

Before fistulas became the gold standard for dialysis and enabled easy, routine care, seniors were often forced to seek treatment in overcrowded emergency rooms. With inferior vascular access, like external catheters, these vulnerable patients then faced increasing risks of complications and serious infections.

Living with kidney failure isn’t easy. Patients must remain committed to threetimes-weekly dialysis sessions, strict diets and complex medication requirements. They often experience fatigue and can have difficulty maintaining the type of active lifestyle that they would like. So, exposing these patients to additional challenges — in terms of inferior vascularaccess services — seems unfair. It’s also poor policy: a recent study of more than 200,000 Medicare patients shows that patients who receive fistulas 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 the hospital.

Fistulas are good for patients and good for Medicare. It’s incredibly unwise for CMS to follow through on proposed cuts that would significantly impact vascular access services for dialysis patients — thereby impacting safe, quality and complication-free dialysis care. Doing so will undoubtedly lead to a spike in infection rates and first-year mortality, undoing more than a decade of progress.

My patients in Texas deserve the best possible care and a chance to live well despite kidney failure. I simply can’t imagine offering them anything less. Hopefully, Congress and Medicare will agree and reject reimbursement cuts that will harm vascular-access care for our nation’s dialysis patients. I urge lawmakers in Texas’ congressional delegation to stand up for our state’s 62,000 kidney failure patients and ask Medicare to stop these cuts.