The phrase “Medicare for all” has become a political rallying cry, but, for patients with end-stage renal disease (ESRD), Medicare for all has been a reality since the early 1970s.
What sounded good in theory nearly 50 years ago, though, has led to a focus on profits at the expense of quality care.
In a recent Freakonomics Radio podcast, “Is Dialysis a Test Case of Medicare for All?,” author and host Stephen Dubner dives into the history of the dialysis industry—arguably one of the most expensive, ineffective facets of U.S. healthcare.
We listened to Dubner’s reporting and gathered five key takeaways:
Beyond transplant, dialysis is the only viable treatment option for ESRD. Yet one in five patients who start dialysis die within a year, with the average survival rate after initiation of dialysis being three years.
But have you ever really thought about what that means for individuals? The cost of dialysis is nearly 1% of the entire federal budget. Put into simpler terms, for every $100 Americans spend in taxes, approximately $1.00 goes toward paying for dialysis.
Traditional dialysis organizations receive much lower reimbursements from Medicare than from private insurance companies. While Medicare can set their preferred rate, dialysis organizations can negotiate high reimbursements from commercial health plans. These reimbursements typically end up being three to four times more than Medicare reimbursement rates.
Experts estimate that about 12% of people on dialysis have commercial insurance, yet dialysis organizations receive about 40% of their revenue and all of their profits from these commercially insured patients.
A 2019 review of these acquisitions showed behavioral changes post-acquisition that impacted cost, quality of care and outcomes. Researchers cited examples of dosage increases on highly reimbursable medications, reductions in skilled nurses in favor of technicians, lower rates of patients being added to the transplant list, higher rates of hospitalizations and increased mortality.
Reimbursement—not clinical need or quality—is driving care delivery.
The previous administration signed an executive order called Advancing American Kidney Health. The goals of the initiative were to:
The current administration is now evaluating what reforms to change and what to keep.
At Strive Health we believe the future of healthcare is value-based reimbursement. In a recent episode of The Cost of Care podcast, Strive Chief Strategy Officer Will Stokes and Medical Director Natasha Dave discussed how kidney care disruptors are prioritizing patients and their overall health.
Chief Strategy Officer at Strive Health Will Stokes says, “As industry veterans, the Strive team has seen the unintended consequences of traditional fee-for-service payment that puts profits at odds with good patient care. We launched Strive to start over in kidney care. We provide kidney care services that re-center care around the patient and a business model that incentivized our patient’s health improving, not their kidneys failing.”
Get to know Strive and learn more about how we’re transforming kidney care.
“At Strive, we’re transforming kidney care. While our mission, vision, and values-based culture play critical roles in that transformation, our people (Strivers) make it happen. Strivers are delivering compassionate kidney care and creating an incredible place to work.”
Let’s do better for kidney disease patients and improve our kidney care system together. Contact us now!CONTACT US