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Modifications to Medicare rules could support care innovation for dialysis

Medicare spends approximately $35 billion annually on care for beneficiaries with end-stage renal disease.

Jeff Lagasse, Associate Editor

In a commentary published in the American Journal of Kidney Diseases, public health researchers suggest adjustments to recently proposed rule changes on how Medicare pays for dialysis services.

Medicare spends approximately $35 billion annually on care for beneficiaries with end-stage renal disease, or kidney failure. That's more than 7 percent of Medicare's total paid claims. Over half a million people receive regular dialysis treatments to manage this condition, with treatment costs averaging about $85,000 a year, according to the study.


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Rule changes were proposed about a year ago that would limit the number of dialysis treatments per week that would be paid for by Medicare. Interest groups including nephrologists and patients themselves were concerned that this would limit patient access to innovative treatment options, such as frequent hemodialysis.

Under the current system, Medicare covers three hemodialysis treatments weekly per patient, but it will often pay for additional treatments when the treating nephrologist provides sufficient medical justification.

The recently proposed rule changes would limit such additional payments to exceptional circumstances -- for example, patients with temporary, acute kidney treatment needs. Although nephrologists would not be prevented from providing any "extra" treatments they believe are needed, they would typically bear the costs of doing so.

The researchers discussed the limitations of the current evidence on frequent dialysis treatment, which to date has yielded mixed conclusions. Their suggested changes to Medicare's dialysis payment system were designed to account for these limitations and give Medicare the flexibility to further modify the system in the future as new evidence comes to light.

Under their main proposal, Medicare would establish a new, separate prospective payment system for frequent hemodialysis treatment.

In that way, they said, nephrologists would have greater clarity about how their dialysis care would be paid for, and free them up to pinpoint better ways to treat their patients.


In the first three years of Medicaid expansion due to the Affordable Care Act, the number of patients with end-stage kidney disease who died within a year of starting dialysis decreased in states that expanded Medicaid, compared to non-expansion states, found research published in October.

The adjusted absolute reduction in mortality in expansion states versus non-expansion states was 0.6 percentage points. Since end-stage renal disease affects more than 100,000 Americans each year, 0.6 percentage points equals hundreds of deaths annually.

Twitter: @JELagasse

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