Dialysis providers face a financial burden from the pandemic
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Patients with end-stage kidney disease are at a disproportionately higher risk to become infected with COVID-19 and require hospitalization compared with older patients and those with disabilities.
Along with other members of the dialysis community, the Renal Healthcare Association has worked on many activities to protect the health and well-being of patients on dialysis. We have worked with the CDC to create a Network Administrator model that would allow federal allocation of the COVID-19 vaccine supply directly to dialysis facilities. Fresenius and DaVita have the direct contract with the government. All other dialysis facilities in the country are able to subcontract through one of these two organizations to order and receive allocations of vaccine. Many facilities and/or dialysis organizations have completed these contracts and are receiving vaccine.
Eliminate vaccine hesitancy
It will be important for the renal community to continue to study the efficacy of the vaccines. A study published in the April 2021 issue of the Clinical Journal of the American Society of Nephrology looked at the antibody response of BNT162b2 (Pfizer-BioNTech) vaccine. Information such as this will be helpful as we make care practice considerations for the future.
We also need to continue to develop strategies to reduce vaccine hesitancy among this vulnerable population, as well as the employees who provide care to them. At the recent National Kidney Foundation Spring Clinical Meetings, Pablo Garcia, MD, of Stanford University presented a poster that showed 22% of respondents in a 943-patient survey indicated they would not likely seek COVID-19 vaccination. Approximately 50% of these individuals were concerned about the adverse events while another 19% were unsure of vaccine efficacy.
Financial burden
Since the inception of the pandemic, the dialysis community has been diligently working to safely care for our patients. Many of the operational changes facilities have made have come at a huge financial cost. Changes in patient scheduling to accommodate lab-confirmed COVID patients, testing for COVID, screening of patients and staff, and reduced productivity have all affected the bottom line.
There has been some help. Many facilities are reporting receipt of federal funds early in the pandemic. Dialysis facilities report that most of these funds were utilized to pay for the following:
- Personal protective equipment (PPE): As facilities implemented safety measures to prevent cross transmission of the virus, higher utilization of PPE has been realized. As well, the cost of PPE increased during the pandemic due to the supply and demand challenges.
- Hazard pay: Dialysis staff members segregated patients with suspected and positive diagnosis of COVID-19 in the outpatient settings. Staff members often worked shifts with only COVID-19-positive patients. In the inpatient settings, dialysis staff members were caring for the large numbers of patients who developed AKI in the COVID units.
- Increased labor costs: Implementation of the safety measures in dialysis required more human resources. Dialysis units added screeners at the front door to monitor patients and visitors who entered the facility. There were increased administrative costs related to the evaluation, development of tools and monitoring of safety procedures in the dialysis unit. Staff education has been required for appropriate use of PPE, understanding standards and care practice changes, isolation requirements and general understanding of COVID-19.
These operational changes made in dialysis facilities are still in effect today, and facilities continue to carry the financial burden related to this.
In recent visits to congressional offices in Washington, DC, the board of directors for the Renal Healthcare Association urged Senators and U.S. Representatives to support additional funding for ongoing management of patients on dialysis during the pandemic. A second ask during these visits included delay of the ETC model until completion of the pandemic. The addition of the ETC model on providers imposes extra burden that is unnecessary at this time.
It is important that Congress recognize the impact of the pandemic to the health care community, including dialysis providers. Financial and operational relief would be a positive first step.
Reference:
Garcia P, et al. Poster 329. Presented at the National Kidney Foundation Spring Clinical Meetings, April 6-10, 2021 (virtual meeting).
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Maria Regnier, RN, MSN, CNN, is the president of the Renal Health Association, which represents independent dialysis providers. She can be reached at mregnier@rha.org.
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