Medicare pays a set amount called the composite rate for most things associated with a dialysis treatment, including dialyzers. My first job working with dialysis patients was in 1978. At that time, the rate Medicare paid for each dialysis treatment was $150.
In 1983, Medicare introduced the composite rate. As I recall, it was around $120 a treatment. Today this rate is around $130 a treatment. Using the U.S. Bureau of Labor Statistics calculator shows that if the 1983 composite rate had kept up with inflation, today Medicare would pay twice what it does for dialysis.
Before the composite rate was introduced, dialyzers were relatively cheap and most clinics used dialyzers only once. Also, at that time, dialysis machines were less automated and patients often complained of headaches, nausea and vomiting, and horrible cramps.
As technology improved, dialyzers and dialysis machines became more expensive. Clinics looked to cost saving approaches including reusing dialyzers to keep costs more in line with payments. Guidelines were established to assure patient safety when dialyzers were reused.
Some clinics have chosen not to reuse dialyzers. This could be for a variety of reasons. Reusing dialyzers costs money in hiring or training personnel, purchasing equipment and supplies, and paying for extra utilities usage. Some companies, like Fresenius, not only have clinics that provide dialysis treatments but they make the machines and supplies to do dialysis (including the dialyzers). Companies that make their own equipment and supplies may cut costs for their dialysis clinics making the cost of not reusing dialyzers more reasonable. Clinics that don’t have the benefits of bulk purchasing or buying from a parent company must pay a higher price for their dialyzers making it more difficult for them to stop reusing as long as the Medicare rate only increases 1-2% every few years.
Finally I don’t think (I don’t know this for sure) it is legal for a clinic to charge a Medicare beneficiary extra for not reusing dialyzers. Medicare regulations require that providers (like dialysis clinics) that accept assignment not charge more than Medicare allows for covered services. Since the composite rate is intended to cover the cost of the dialyzer, Medicare might look on a clinic that charged extra for a single use dialyzer as fraud and abuse. No clinic or corporation wants to deal with the hassle or bad press a Medicare fraud and abuse charge brings. Other insurances may not have these restrictions and patients that wish not to reuse should check with their insurers.
Finally, patients have the right to request not to reuse dialyzers. However, clinics have the right to tell patients if they want to get treatment at the clinic in question that they will need to reuse. If this is not satisfactory to the patient, he/she can ask the clinic for help to find another place to dialyze that does not reuse or ask if the clinic requires home hemo patients to reuse.