Physician fee cuts are leading to disparities in vascular access care
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Congress must hear this message: Ongoing cuts in the Medicare Physician Fee Schedule for office-based providers will continue to impact access to care for patients on dialysis across the United States.
The latest version of the 2024 Medicare Physician Fee Schedule (MPFS), doubles down on the harmful cuts to community-based providers.
Policymakers must understand that leaving these year-over-year cuts in the MPFS unaddressed will continue to shatter our already fragile health system across the country. The federal Medicare reimbursement rates for local dialysis vascular access centers are so inadequate that many are forced to close, especially those in rural areas and in underserved communities.
Access to care
In our health care system, there exists a stark reality of persistent disparities and injustices faced by vulnerable patients on dialysis. Already burdened by the challenges of ESKD, patients are further subjected to an unequal distribution of quality care and outcomes. The time has come for us to address these inequities and fight for a system that prioritizes the well-being of all patients on dialysis.
There is hope. This year, U.S. Reps. Gus Bilirakis, R-Fla., Tony Cardenas, D-Calif., Greg Murphy, MD, R-N.C., and Danny Davis, D-Ill., introduced bipartisan legislation that, if passed, would put an end to the repeated reductions in Medicare reimbursements for office-based specialists. By doing so, this legislation would prevent significant disruptions in access to care for patients on dialysis.
Bloodstream infections
Reducing bloodstream infections is a necessary step forward to improving the lives of patients on dialysis, as evident in a newly published CDC report that sheds light on the staggering disparities prevalent in dialysis vascular access care. Alarmingly, the report found patients on dialysis were 100 times more likely to experience Staphylococcus bloodstream infections, a leading cause of death for dialysis patients, compared with the general population. Hispanic patients experience a 40% higher infection rate than non-Hispanic white patients.
One distressing finding from the report highlights the disparities faced by different racial and ethnic groups. ESKD rates were found to be four times higher among the Black population and more than two times higher among the Latino population. These numbers are not a coincidence but rather reflect the systemic barriers and biases that perpetuate unequal access to care and contribute to poorer health outcomes for marginalized communities.
Patient satisfaction
Expanding the availability of specialty care providers in office-based settings is a winner for patients. Dialysis access centers have consistently demonstrated better patient satisfaction and improved outcomes compared with hospital-based procedures.
Additionally, hospital-based dialysis vascular access services are more expensive, placing an added financial burden on patients and health care systems alike. We must address these issues and work toward providing patients with the freedom to choose the care setting that best meets their needs, ensuring their safety, well-being and financial stability.
It is time for policymakers in Washington, D.C., to prioritize the needs of patients with kidney disease and put an end to the disparities that continue to plague our health care system.
- References:
- Health disparities in hemodialysis-associated Staphylococcus aureus bloodstream infections — United States, 2017–2020. https://www.cdc.gov/mmwr/volumes/72/wr/mm7206e1.htm. Published Feb. 10, 2023. Accessed Aug. 2, 2023.
- Legislators introduce bill to increase Medicare payments for vascular access procedures. https://www.healio.com/news/nephrology/20230607/legislators-introduces-bill-to-increase-medicare-payments-for-vascular-access-procedures. Published June 7, 2023. Accessed Aug. 2, 2023.
- Medicare and Medicaid Programs; CY 2024 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program. https://www.federalregister.gov/documents/2023/08/07/2023-14624/medicare-and-medicaid-programs-cy-2024-payment-policies-under-the-physician-fee-schedule-and-other. Published Aug. 7, 2023. Accessed Aug. 7, 2023.
- For more information:
- Terry F. Litchfield, MPA, CPC, is president of Access Solutions, which provides patient advocacy consulting services. She can be reached at terryflitchfield@gmail.com.
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