Update 11/14/13: I keep getting questions about Obamacare and how it impacts on dialysis patients. Therefore, I’m posting this page again. I hope, if you have questions, you’ll put them in the comments section. Also, if you aare experiencing problems with your health insurance as a result of ACA implementation, let us know. Thanks.
Update 6/5/13: The simple answer to the most frequent question about ObamaCare and dialysis is: NO! No one is going to be denied dialysis (or chemo) after age 75!
There’s NOTHING in the Affordable Care Act that says anything like that. It’s simply a lie perpetrated by some people that don’t like ObamaCare/ACA. Why they would perpetrate a lie like that, I don’t know. It’s shameful.
(Scroll to the bottom for other updates!)
I didn’t realize how much MISinformation was available on the topic of ObamaCare. When I googled it, it took several screens before I got to something that wasn’t from a propaganda website so lacking in facts, it was total fiction. So, obviously, some accurate information is necessary about what dialysis patients need to know about ObamaCare or, more properly, the Patient Protection and Affordable Care Act (PPACA).
There are websites making all sorts of wild-haired claims like everyone over the age of 75 will be denied dialysis, that not everyone who needs dialysis will get it under Medicare, care will be rationed and under the scrutiny of “death panels“, etc. Fact is, none of this is true.
One particularly factual review was done by Jack Ahern (no fan of ObamaCare) and published in RenalBusiness.com titled: “Dialysis Specific Provisions of ObamaCare”. He identifies two sections of the 2000+ page law that apply directly to dialysis; sections 3202 and 10336.
SEC. 3202. BENEFIT PROTECTION AND SIMPLIFICATION.
(a) LIMITATION ON VARIATION OF COST SHARING FOR CERTAIN BENEFITS—Patient Protection and Affordable Care Act – SEC. 3202. BENEFIT PROTECTION AND SIMPLIFICATION.
(a) LIMITATION ON VARIATION OF COST SHARING FOR CERTAIN BENEFITS.—Section 3202 prohibits Medicare Advantage plans “from charging beneficiaries cost sharing for chemotherapy administration services, renal dialysis services, or skilled nursing care that is greater than what is charged under the traditional fee-for-service program.” The effective date for this requirement is for plan years beginning on or after Jan. 1, 2011.
This means that a Medicare Advantage plan or other Medicare HMO can’t charge patients more than they would pay under traditional Medicare. This specifically includes dialysis. That’s a good protection for patients because it assures those plans won’t be able to gouge dialysis patients if they decide to do so.
Section 10336 also specifically mentions dialysis and the oral medications we’re given as part of our treatment for ESRD and whether or not they should be part of the “bundle” for which providers are paid.
Just a note here about “the bundle”. It’s a recently created payment system whereby dialysis centers and providers are paid a set amount per patient for a group of services like dialysis. Rather than charge specifically for each service (fee-for-service), providers are paid a flat fee for a bundle of services. Medicare (or CMS) has been going back and forth with providers and patient advocacy groups like Dialysis Patient Citizens for a couple years to smooth this system out and make it beneficial to patients while saving money for Medicare. By all accounts, it is working.
With that in mind, Section 10336 directs that the GAO (Government Accounting Office) will perform an analysis to review how adding phosphate binders and calcium medications to the bundled payment will effect patients.
Such study shall include an analysis of—(A) the ability of providers of services and renal dialysis facilities to furnish specified oral drugs or arrange for the provision of such drugs; (B) the ability of providers of services and renal dialysis facilities to comply, if necessary, with applicable State laws (such as State pharmacy licensure requirements) in order to furnish specified oral drugs; (C) whether appropriate quality measures exist to safeguard care for Medicare beneficiaries being furnished specified oral drugs by providers of services and renal dialysis facilities; and (D) other areas determined appropriate by the Comptroller General.
That GAO study was completed recently and the GAO believes these drugs should be part of the bundle and that it would benefit patients if they were.
Per the GAO, the three key reasons for including oral-only ESRD drugs in the bundled payment for dialysis care are:
- To promote more efficient dialysis care, by allowing ESRD facilities to gain financially by reducing costs.
- To promote clinically appropriate care by removing financial incentives to use certain drugs over others.
- To improve access to oral-only drugs for certain beneficiaries, such as those who lack separate prescription drug coverage.
The next question is how much that bundled payment should be and how best should it be covered. Those meds are currently paid as part of Medicare Part D (drug benefit) and the GAO believes they should be paid under Part B (out-patient treatment). The GAO reports:
In fact, “Approximately 17 percent of all Medicare beneficiaries on dialysis did not have any prescription drug coverage in 2007. However, when oral-only ESRD drugs are included in the bundled payment, all beneficiaries on dialysis will be eligible for coverage for these drugs under Medicare Part B, and will not be subject to the Medicare Part D coverage gap,
Another score for patients as part of ObamaCare! If binders and calciumites are paid for as part of the bundled payment to providers, patients won’t have to pay separately for these under their Part D and, for those without Part D, they will get them as part of their dialysis treatment.
However, there’s some concern that providers will under serve by not giving patients enough to save money. But, since the measures for phosphorus and calcium are part of the periodic testing, this should be a reasonable control. If patients at a center have continued high phosphorus, for example, the center could be investigated for under serving binders. So, there are safeguards in place to monitor that.
Now, back to the propaganda being pumped out about ObamaCare. There’s a old saying: “A lie is halfway round the world before the truth has got its boots on” and when it’s about ObamaCare, it’s absolutely true. I went through pages and pages of material to get down to some facts. It’s really upsetting that politically motivated interests are pumping out falsehoods about Medicare as a mechanism for scaring people but it’s effective unfortunately and there are volumes of misinformation on the internet. Even on some well respected websites like Amazon.com and AllNurses.com there are a host of popular myths being passed along about medical treatment under ObamaCare.
On Amazon.com, a writer claims personal knowledge of Dr. Suzanne Allen, head of emergency services at the Johnson City Medical Center in Tennessee, saying:
“Oh, yes. We are seeing cutbacks throughout the services we provide. For example, we are now having to deal with patients who would normally receive dialysis can no longer be accepted. In the past, there was always automatic approval under Medicare for anyone who needed dialysis — not anymore.”
The problem is, it’s not true. Yes, according to FactCheck.org, there is a Dr. Allen and she’s at that location but she never said anything of the sort. In fact, she’s really embarrassed that such lies would be attributed to her. It tarnishes her professional career. She also sees ObamaCare as a benefit to patients. A statement from the hospital says:
“From a hospital point of view, if there has been any effect from the healthcare reform law, it has been increased access for patients.”
Another popular myth is about the Ethics Panels. In the same false statements by the above mentioned writer on Amazon.com:
“Regardless if you have private health care coverage now (I have Aetna Medicare Part B) — it will no longer apply after 2013 if the Ethics Panels disapprove of a procedure that may save your life.”
Again from FactCheck.org about these “panels”:
Nowhere in the thousands of pages of the Patient Protection and Affordable Care Act passed in 2010 is there any mention of “ethics panels.” In addition to that, the law makes no mention of any provisions specifically affecting those 75 and older.
(The myths about Dr. Allen and panels and denial of services based on age is also debunked by Snopes.com in their website page dedicated to this question.)
Every hospital has an Ethics Panel that reviews the performance by physicians in any questionable situation. It’s part of the hospital’s quality assurance and legal liability protection. It has little to do with hospital policy or procedure and nothing to do with what services patients receive.
Yet there still are wild speculations being bandied about in emails and forums like “By law, a panel of government officials will be empowered to make changes to Medicare”. Of course there are government officials making changes to Medicare! It’s a government program! But those changes aren’t made easily or in some smoke-filled backroom. They can’t. All changes to Medicare are subject to review and public comment. Groups like Dialysis Patient Citizens are constantly providing input to Medicare about their proposed changes and only after months and months of deliberation and revision are changes finally made. However, I should point out that Private Insurance companies can make changes to your policy and coverage without your input and review. So, having “government officials empowered to make changes” is not a bad thing because, at least, we have some say in those changes; not so with private insurance.
If you have someone spouting off about these so-called Death Panels or other popular myths they believe are part of the ACA, the link in the quote above goes to every page of the law and they can read it for themselves. If they are such experts, they should at least have read it, eh?
I suspect there will be no end to the scary tales spun about ObamaCare by political propaganda machines. However, for dialysis patients, there are only positive enhancements to our medical treatment due to the ACA and there should be more to come as the other parts of the law come into effect over the next couple years.
(My thanks to RenalBusiness.com and Jack Ahern, MBA for providing excerpts from their website and blogs. I especially thank Mr. Ahern for making a complex issue such as ACA simple and understandable.)
Update 1/11/13: Great podcast from DPC’s Jessica Nagro about the Affordable Care Act (ObamaCare) and how it impacts on dialysis patients. Hear it here. (Sorry, DPC changed their website and this no longer exists or I can’t find it.)
Update 12/1/12: I’m republishing this as there’s been a huge amount of discussion and more misinformation passed along lately about ObamaCare and how it impacts on dialysis. I had hoped that the information about it would have improved since I published this in October but it hasn’t. So, in the interest of clarification, I’m touching upon this again.
(Also, here’s a great article from RenalBusiness.com and Kasia Michalik about possible Medicare cuts and impact on dialysis patients. Good read. Read it here. )
DevonTexas © 2012