From the perspective of policy makers, patient advocates and health care providers, chronic kidney disease and kidney failure present the following series of important questions:
- How do we, as a nation, tackle the economic and physical implications of a health care epidemic that when undiagnosed or left untreated, results in loss of vital organ function or even death?
- How do we stop kidney disease before it takes hold?
- How can we provide state-of-the-art care in a cost-effective manner when we can’t halt the disease?
As distressing as CKD and ESRD are, on paper, for those charged with addressing its consequences on a national scale, the pain for patients themselves is exponentially greater.
Millions of Americans, many with no obvious warning, will be diagnosed with CKD and learn that the functional longevity of their kidneys will depend on strict adherence to medication, diet and lifestyle changes. Three-quarters of a million others diagnosed with ESRD will find their lives forever changed. They will incur the costs — both financial and personal — of dialysis care, which will be required several hours a day, several days a week for the rest of their lives. They will grapple with the fact that, absent a kidney transplant, their lives, livelihoods and futures are, in many ways, out of their hands.
It is a helpless feeling, made even worse by the reality that many of these patients have little control over their care. Due to the current state and federal policies, patients do not always have access to the health insurance that is the best for them or their families. They are treated differently from other Medicare beneficiaries in terms of choice.
For years, the National Kidney Foundation and other organizations have been committed to helping patients cope with the realities of kidney disease and kidney failure. We have been incredibly excited and passionate about Kidney Care Partners, Kidney Care FIRST — particularly its policy avenues geared toward giving Americans more power and choice, when they find themselves feeling helpless in the face of this disease.
Making sure patients with kidney failure have the health care they need has always been paramount, which is why patients diagnosed with ESRD become eligible for Medicare regardless of age immediately while on home therapy or after 4 months on in-center hemodialysis. Anyone with an ESRD diagnosis has a period of 30 months in which they can remain on their private health plan (or COBRA) while Medicare acts as secondary payer. However, in many cases, maintaining private coverage for a longer period would better serve these vulnerable patients’ needs.
Empowering patients with greater freedom to choose what works best for them and their families is possible by extending the Medicare secondary payer period by an additional 12 months. It is a fairly straightforward policy that could be helpful in many ways: for example, patients might want to stay with their existing plan that covers dependents; or offers better benefits than Medicare; or they may not be able to get Medigap in their state.
Allowing patients flexibility in the face of kidney failure not only empowers them, but also offers some breathing room when they are likely up against significant financial difficulties. It is also achievable by ensuring all patients with ESRD have access to Medigap plans — a decision currently made individually by the states.
Medigap plans help to defray the cost of Medicare services which, for patients with ESRD, can be substantial. Medicare Part B’s 20% cost-sharing and lack of an annual out-of-pocket maximum quickly add up for patients on limited incomes. Currently, 30 states require insurers to offer Medigap coverage to Medicare beneficiaries with ESRD who were younger than age 65 years, but we feel this coverage should be made available nationally — just as Medicare is.
The depth and breadth of CKD and ESRD in the United States require a unique and comprehensive approach. These Americans don’t need or want handouts, but they deserve policies and practices that equip them to manage their care and optimize their health. Kidney Care FIRST provides a thoughtful roadmap to guide patients toward living their best lives, despite a life-changing diagnosis.
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Keith Bellovich, DO, is an associate clinical professor at Michigan State University College of Osteopathic Medicine and Medical Director of Nephrology Services at Ascension St. John Hospital in Detroit. He is a Nephrology News & Issues Editorial Advisory Board Member.
Disclosures: Bellovich reports he is a medical director and joint venture partner with DaVita Inc.