Change for Obama's Transition Team

I just submitted the following as a comment in the Submit Your Ideas section in the Healthcare Agenda area of Change.gov. The more Obama’s healthcare transition team hears about home dialysis and more specifically more frequent dialysis the better. If we’re going to able to raise issues specific to home dialysis then we’re going to have to start somewhere and this is a simple thing for all of us to do. You can edit mine or, better yet, write something in your own words, but please submit something.

[I]With over twenty million having some kind of kidney problem; one in nine adults has a degree of chronic kidney disease; over 82000 die of kidney failure each year; over 470000 either requiring dialysis or a transplant to survive; and of the over 70000 waiting for a transplant, only 17000 will get one this year. The cost of caring for the End Stage Renal Disease Program represents approximately 25% of the Medicare budget. ESRD is the only disease covered by Medicare irrespective of age. Additionally, because of the near epidemic of diabetes, high blood pressure and obesity, the numbers are only going to grow and add to the healthcare problem as we know it. . The dialysis population has been growing at about an annual rate of approximately 8%. With these tremendous increasse in the demand for dialysis services, the number of centers, doctors and trained nurses and technicians will not be able to keep up.

What we need is a new paradigm is the care of dialysis patients. Actually, that paradigm has emerged, but is not being fully utilized. That paradigm is home dialysis; both peritoneal and hemodialysis. From a health standpoint, outcomes have shown home dialysis to be better for the patient. I know this for a fact in my case. I have been doing home hemodialysis since February of 2006 and had dialyzed in-center for three years before that. From a practical standpoint, home dialysis represents the possibility of providing self-care treatment while it is becoming more difficult for in-center clinics to keep up with the growing demand. Finally, home dialysis may actually be significantly less expensive to the overall health budget. Though the cost of home dialysis treatments may be approximately the same or even slightly higher than in-center dialysis, the decreased use of many expensive drugs, such as erythropoietin, phosphate binders, and antihypertensive agents and the decrease in hospitalizations greatly offset this difference. If one was to analyze Medicare Part A and B for each type of dialysis patient, I’m confident it would indicate the home patient’s kidney disease is less expensive to manage in the overall. It has been proven that more frequent dialysis leads to a healthier and more productive life for dialysis patients, many of which can go back to work and rather than getting disability benefits can actually earn a wage and contribute taxes.

Kidney disease isn’t going away; it’s just going to get more significant as time goes on. Government needs to get smarter about how it deals with this mushrooming health problem.[/I]

Hi Rich,

I just bookmarked that site yesterday, but haven’t posted anything yet. Incidentally, folks with ESRD represent about 1/2% of the Medicare population, and account for 6-7% of the costs–not 25%. :slight_smile:

Thanks, I stand corrected. Now write something!

With 1/2% of the Medicare population representing 6-7% of the cost outlay, I would think they would want to learn more on how home dialysis can cost less in the overall picture. BTW, does that 6-7% figure include Parts A,B and D?

I’d have to check, but I believe so. :slight_smile: I will plan to post something there, too, and encourage EVERYONE to do what they can to get this issue on the table for the new administration!

Hi Folks

Thanks Rich… Have something in the works. Just need Eleanor to proof read it.

Thanks
Bob O’Brien

As you probably know, Tom Daschle has been nominated to be Secretary of HHS and the head of the White House Office of Health Reform. Jeanne Lambrew has been named his deputy at the White House. I revised my previous email to change.gov to reflect Dori’s corrections and emailed to Daschle and Lambrew at the following addresses.

tdaschle@americanprogress.org

jlambrew@americanprogress.org

Let’s try to be proactive and get more people to advance the home dialysis agenda. Let’s push for payment for more frequent dialysis and home training.

      We have the 2006 economic data from the USRDS ([Section K: Economic costs of](http://www.usrds.org/2008/ref/K_Economic_costs_of_ESRD_08.pdf) [end-stage renal disease](http://www.usrds.org/2008/ref/K_Economic_costs_of_ESRD_08.pdf)) table K-1 gives the total cost in 2006 as $20,345,323,888. The next table K-2 breaks it down into the component costs in 2006: total inpatient $7,045,895,137; total out patient $7,830,376,418; total physician payments $4,292,729,346. The missing billion is for skilled nursing, in home health aides and hospice. It looks to me that Part D is not included.

According to this Keiser fact sheet in 2006 Medicare benefit payments totaled $374 billion. This also looks to be without part D spending.

To calculate percent you take ESRD payments divided by total Medicare payments = 0.054399261732620320855614973262032 aka 5.4%. That’s lower than I thought it was, is there something wrong with my numbers?

Since Medicare reimbursement for dialysis is not yet indexed for inflation it increases at a slower rate than Medicare generally and growth in the number of people needing dialysis is a lower rate than the number of people entering Medicare, I think. If true it would mean that ESRD spending as a percentage of Medicare Part A and Medicare Part B should be decreasing. That in 2008 it was less than 5.4%. I think we should try to pin these numbers down – it isn’t in our interests to make CKD5 seem more expensive than it is; 5% sounds better than 6 to 7%.

What Medicare pays for a dialysis treatment – on average $115 to $145 is a hell of a deal. Less than a haircut for your average politician.