A proposal to reduce Medicare reimbursements to kidney dialysis providers by nearly 9.5 percent next year could result in reduced profit margins for operators, but also for recipients.
Our Los Angeles Social Security Disability Insurance attorneys understand that the approximately $1 billion paid annually to kidney dialysis centers in the U.S. comes from federal Medicare payments, which is the health plan extended to the disabled and elderly. The federal government has suggested phasing in the reduction over the course of more than 12 months. Still, providers have called the proposal "dramatic," noting that they come in addition to the automatic 2 percent reduction that kicked in earlier this year.
Medicare covers about 85 percent of the 400,000 patients who receive dialysis treatments for their kidney failure/end stage renal disease.
The ultimate concern, say some providers, is that such measures could potentially threaten access to these facilities, if they are forced to close. That could leave some of the nation's sickest patients in dire straits. Many of those who receive dialysis treatments are often too sick to work.
Chronic kidney failure is the gradual loss of kidney function. It's not a condition one can survive without regular treatment because your kidneys are responsible for filtering excess fluids and wastes from your blood, which are then excreted in urine. When you reach the end stages of the disease, or acute kidney failure, wastes and electrolytes can accumulate in your body at levels that are fatal.
Dialysis treatments serve as an artificial filtering process to clean your blood.
Some diseases that are known to cause chronic kidney failure include:
- High blood pressure;
- Type 1 or type 2 diabetes;
- Polycystic kidney disease;
- Prolonged obstruction of the urinary tract, such as with kidney stones, enlarged prostate and certain types of cancers;
- Vesicoureteral reflux;
- Recurrent kidney infections.
For many people with chronic or acute kidney failure, the only way to avoid lifelong dialysis treatments is with a kidney transplant. Many patients may be too old or weak to endure such a procedure.
Not everyone with chronic renal disease will qualify for federal disability benefits, but it's likely that if you are undergoing dialysis treatments that you will meet the criteria, as laid forth in the Social Security Disability Blue Book listings, Sections 6.02 and 6.06.
Generally, in order to meet the disability listing, one must have:
- The need for regular dialysis;
- Completion of a kidney transplant;
- High levels of creatine, combined with symptoms of damage;
- Nephrotic syndrome.
Dialysis providers say many already lose money on Medicare patients. Those funds are made up by payments from commercial insurers and individuals, which are only about 15 percent of the total.
So the concern about even further reduced Medicare payments is that insurance premiums for those who have it are going to get even higher. This becomes all the more reason for individuals who are suffering from a kidney-related condition to consider evaluation for SSDI.
Los Angeles Disability Benefits Attorney VINCENT HOWARD at HOWARD LAW can help. Call toll-free at 1-800-872-5925 or send us a message online.
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