Economics of End-Stage Renal Disease Chronic kidney disease can progress to end-stage renal disease rapidly for individuals who have comorbid conditions such as diabetes and or hypertension. This country faces increasing cost of health care associated with the aging population and chronic diseases. The cost, quality, and access to health care for end-stage renal disease (ESRD) patients are being challenged by today’s economy and changes in health care policies. The purpose of this paper is to identify the challenges surrounding the treatment of ESRD. Major Reimbursement Mechanisms
Since the early 1970’s, Medicare has been the major source for reimbursement in the treatment of ESRD ( Rettig, 2011). In the beginning, Medicare was available only for the elderly until provisions were made by the Social Security Amendment to include the disabled, which incorporates those who require kidney transplants or dialysis ( Rettig, 2011). Other sources for reimbursement include Medicaid and private health insurance companies. According to Rettig (2011), in 2008 the cost of treating ESRD totaled $39.5 billion, Medicare covered 67.8 percent. The remaining amount was paid by employer-sponsored group health plans or directly by patients. Inglehart (2011) states “if the patient is covered by an employer-sponsored health plan at the time of diagnosis, that plan must be the primary payer for the first 33 months of treatment” (para 3).
Economics of Providing ESRD Treatment
The cost of providing treatment for ESRD patients can vary for each individual depending upon the type of treatment, severity of the disease, and comorbidities. The two for profit companies Fresenius Medical Care (FMC) and DeVita are the top providers in care within the dialysis community (Sullivan, 2010). These companies are investigating ways to cut costs and maintain control of the dialysis industry. In the past, “reimbursement was based on basic treatment with additional payments for ancillary drugs and testing” (Sullivan, 2010, p. 47). Currently, the reimbursement for the renal community is a “bundled” rate; this method of payment is to include both dialysis treatment as well as any additional drugs required during treatment (Sullivan, 2010). This change in reimbursement was implemented to assist in cost control of the drugs necessary for quality treatment and to ensure profit for companies providing treatment (Sullivan, 2010). A complication of dialysis is anemia. Anemia is controlled by use of a drug called epoetin alfa and iron (Thompson, 2010). Prior to the “bundled” payment plan facilities administered epoetin alfa based on the patients need to keep their hemoglobin at a target level (Thompson, 2010). A study conducted at Grady Health Systems in Atlanta, by monitoring patient’s hemoglobin levels found administering this drug subcutaneously versus intravenously, facilities could decrease the amount of the drug used lowering the cost of treatment (Thompson, 2010).
Patient Options
Hemodialysis, peritoneal dialysis and kidney transplant are the treatment options for the ESRD patient. According to Sullivan (2010), kidney transplants provide the best quality of life and cost effective treatment for ESRD patient; unfortunately, the supply of donors does not correlate with the demand. Hemodialysis is most commonly performed in an outpatient clinic or hospital; however, it is possible for the patient to administer at home. A patient requiring hemodialysis is committed to treatment three times a week ranging from three and half to four and a half hours a day (Sullivan, 2010). A patient must have a vascular access where blood is pumped out of the body, to the machine flowing against a dialysate in an artificial kidney to remove toxins from the blood (Sullivan, 2010). Patients usually prefer the outpatient setting because of complexity of this process and the potential occurrence medical problems (Sullivan, 2010).