Centers for Medicare & Medicaid Services (CMS) recently took another step in a series of funding cuts for some of the most vulnerable patients in the U.S. healthcare system. These cuts threaten a system of care that has provided significant, systematic improvements in clinical outcomes and survival rates for patients with kidney failure.

In its proposed rule, CMS recommends reducing reimbursement for dialysis providers by modifying the bundled payment for dialysis (the ESRD Prospective Payment System – PPS). The proposed rule would reduce provider reimbursement by nearly 10 percent, which is particularly devastating because the current reimbursement rate doesn’t cover the cost of dialysis adequately. This additional cut would bring reimbursement significantly below the necessary rate.

CMS has focused narrowly on just one component of the bundle in this proposed rule – drug utilization – while neglecting the larger payment system and ignoring advances in quality outcomes for patients. Dialysis patients have better survival rates and better clinical outcomes than ever before, but this rule would punish providers rather than reward their successes in helping patients live longer and live better.

While there has been a decrease in the utilization of certain drugs (primarily those used to treat anemia) provided to end stage renal disease (ESRD) patients, it’s important to consider that there have also been cost increases in those and other drugs, as well as many other elements of care provided by dialysis centers.

Key members of Congress and patient advocates have repeatedly urged CMS to look holistically at reimbursement. Those calls have gone unheeded. Unfortunately, now these proposed cuts may threaten access to care for one of America’s most medically fragile patient populations.

The kidney care industry has already absorbed significant reimbursement cuts, and this latest round of reductions could be devastating to patients. The truth is, many dialysis centers with a large majority of Medicare patients already don’t break even financially. Providers are able to treat the patients at these clinics only because other clinics have a higher number of non-Medicare patients, and those centers absorb additional costs.

These cuts, if they are approved, may force center closures across the country, which will impact patient care significantly.

CMS must reconsider these ill-advised reductions.

“Somewhat ironically, CMS itself acknowledges in the proposed rule that these cuts will have an impact on patient access to care and may well create unintended consequences.”

• Dialysis centers may be forced to reduce operating hours and/or change staffing patterns, making it more difficult for patients to fit dialysis treatments into daily life – creating problems for them in terms of work and family obligations.
• Other dialysis options, such as nocturnal in-center dialysis and home hemodialysis, could be limited.
• Patients might lose facilities in their local communities and may have to drive long distances to find this necessary care.

The ESRD community is united in its belief that it is vitally important for CMS to consider the actual costs to operate an ESRD facility and use those costs in the calculation of reimbursement. No cut to the current dialysis reimbursement rate is acceptable.

Whether you are a patient, caregiver, physician, family member or other concerned citizen, your voice can make a difference in fighting this ruling. Congress must take action in the next several weeks to address this dialysis funding crisis. Here’s what you can do:

• Visit DaVitaAdvocacy.com to urge your congressional leaders to call CMS today. It takes less than one minute to submit your comments.
• Educate your friends and family and encourage them to reach out to their congressional leaders on this issue.

Patients, physicians, families, friends and caregivers need to take action today; this ruling must not stand. July and August will be critical months to take our message to Washington: no more cuts for dialysis patients and their providers.

As former U.S. Vice President Hubert H. Humphrey once said,

“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life, the sick, the needy and the handicapped.”

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A version of this post also appeared on “Renal Business Today“.