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The Washington Monthly Examines the “Dialysis Machine” in Its Latest Issue

The investigative report looks at how Medicare coverage steers low-income and minority kidney patients toward dialysis interventions

Bethesda, MD - Anne Kim, Senior Writer at the Washington Monthly, examined the impact of class and racial disparities on how dialysis services are delivered. Ms. Kim’s article states that “Everyone with kidney failure, also called end-stage renal disease, is covered by Medicare. And Medicare guarantees payment for every dialysis session. As a result, the treatment of kidney failure is a volume-centered business aimed at keeping dialysis centers running.” In 1972, Congress passed legislation which authorized the End Stage Renal Disease Program (ESRD). This legislation extended Medicare coverage to Americans if they had stage five chronic kidney disease (CKD) and were otherwise qualified under Medicare’s work history requirements. Previously only those over 65 could qualify for Medicare benefits.

This entitlement is nearly universal, covering over 90% of all US citizens with severe CKD. While covering these patients is definitely good public policy, it does create unintended consequences. As the article points out, the guaranteed bundled payment system “… effectively steers low-income and minority patients with kidney disease toward dialysis and away from superior options, particularly transplants.” MTPPI’s President, Dennis Cotter, was quoted in the article as well, likening certain respects of modern day dialysis to an assembly line: “You fill up a facility with so many stations, you make sure somebody is sitting in each of those chairs around the clock. It’s the Henry Ford production model.”


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