JustCare

Tag: ESRD

  • For-profit kidney dialysis: Profits before people

    For-profit kidney dialysis: Profits before people

    In a recent episode of Last Week Tonight, John Oliver takes on the kidney dialysis industry, particularly DaVita, the for-profit company that controls a large piece of the kidney dialysis business in the U.S. Oliver exposes the various ways for-profit kidney dialysis companies put profits before people, compromising people’s health.

    For background, End Stage Renal Disease (ESRD) or kidney failure is the 9th leading cause of death in the U.S.  Today, 500,000 adults have ESRD; 7,000 outpatient clinics provide dialysis. Another 17 percent of the adult population has chronic kidney disease, which can turn into kidney failure, if not detected and properly treated, People with kidney failure need dialysis–a three to four-hour process, three times a week, by which people’s blood is withdrawn, cleaned and returned to their body–to stay alive.

    The number of people needing dialysis has grown substantially since 1972, when Richard Nixon expanded Medicare to cover anyone with ESRD. At that time 10,000 people had ESRD.

    Oliver makes a compelling case that DaVita and other for-profit dialysis companies are not providing people with ESRD the care they need. For example, Oliver reveals that at least some DaVita employees appear to promote dialysis over kidney transplants. Yet, dialysis is not a long-term solution for people with ESRD, whose risk of death increases each year. They need a kidney transplant, if they are eligible for one, which can prolong their lives significantly.

    Oliver also highlights DaVita’s poor infection control practices, alleged improper payments to doctors to refer patients to DaVita and overcharges to Medicare for drugs. (Seven years ago, Pro Publica reported unsafe and unsanitary conditions in many dialysis facilities.) While denying any wrongdoing, DaVita settled a lawsuit alleging that DaVita gave kickbacks to doctors for referring them patients, for $389 million. Again denying any wrongdoing, DaVita settled a whistleblower suit claiming that DaVita overcharged Medicare for drugs, for up to $495 million.

    DaVita and one other for-profit company, Fresenius (which denied any wrongdoing but agreed to a $250 million settlement of a lawsuit alleging that it caused patients fatal heart problems and strokes) own seven in 10 of the dialysis clinics in the U.S. It’s hard to understand how Medicare gives many of these clinics a four-star rating for the quality of their patient care.

    The cost of dialysis is enormous, 1 percent of the federal budget. In 2013, Medicare spent $31 billion on dialysis treatments for people with kidney failure. DaVita posted $789 million in profits in 2016.

    Medicare needs to do a better job of overseeing DaVita, Fresenius and other for-profit dialysis companies to ensure, among other things, that they help patients understand the value of a kidney transplant over dialysis, and provide good quality care to their patients.

    Here’s more from Just Care:

  • Social Security and Medicare benefits for people with disabilities

    Social Security and Medicare benefits for people with disabilities

    About 10 million people qualify for Social Security and Medicare on the basis of a disability.  Here’s what you need to know about Social Security and Medicare benefits for people with disabilities:

    Apply for Social Security Disability Income at your local Social Security office or online. Call Social Security at 1-800-772-1213 to find out where to go. If you qualify for railroad disability annuity income, go to your local Railroad Retirement Board. (To learn more about Social Security disability policy and how it relates to the recent budget deal, click here.)

    Medicare: You automatically qualify for Medicare when you are under 65 once you have been receiving Social Security Disability Income for 24 months or railroad disability annuity checks. And, there is a five-month waiting period before your Medicare benefits kick in. You do not need to do anything to get Medicare Part A and B.  Your Part B premium will be deducted from your Social Security check. You should not turn down Part B unless you have primary insurance coverage through your or your partner’s current job and you confirm that with the employer offering the coverage and Social Security. You want to avoid being without medical coverage or paying a premium penalty for Part B. (And, keep in mind that Medicare covers only about half your health care costs, so you’ll need supplemental coverage. If your income is low, there are several programs that can help.)

    If you have ALS or Lou Gehrig’s disease, you will automatically be enrolled in Medicare the first month you receive Social Security Disability Income or railroad disability annuity income. There is a five-month waiting period after you are determined to be disabled until you begin receiving benefits. Be sure to make clear that you have ALS to avoid the additional 24-month waiting period for Medicare.

    If you have End Stage Renal Disease (ESRD), you should apply for Medicare through your Social Security office, even if you are a railroad worker. Social Security will need supporting documentation about your disease from your doctor and dialysis center. When Medicare begins depends on your treatment.

    • If you are in a self-dialysis training program, Medicare begins on the first day of the month you begin the program. You must begin the program before the third month of your dialysis and you will need support from your doctor that you will complete the training program and do self-dialysis. Otherwise, Medicare begins the first day of fourth month of your dialysis.
    • If you are receiving a kidney transplant, Medicare begins when you begin receiving health care services for the transplant. Medicare coverage begins no sooner than the two months before the month you receive the transplant.