Updated: September 12, 2013 6:14AM
James Myers sat quietly in a large chair as his blood was artificially cleansed of waste by a whirring dialysis machine that beeped every few seconds.
With a blanket draped over his legs and a catheter connected to his chest, Myers sat patiently inside the Fresenius Medical Center in Crown Point. He visits there three times a week for at least four hours each time to undergo hemodialysis, which replaces the function of his failing kidneys.
The 59-year-old Crown Point man suffers from polycystic kidney disease, which took the lives of several family members, including his father. Though Myers was diagnosed in his younger days, his positive lifestyle choices the past three decades only delayed the inevitable.
His genetic fate caught up to him last summer. He’s been on dialysis ever since.
“I have no choice. You either submit to dialysis or you die,” said Myers, who also is on three kidney transplant lists.
Myers is among more than 400,000 Americans with irreversible kidney failure, and roughly 85 percent of them rely on Medicare’s end stage renal disease benefit for life-sustaining dialysis care. But a recent proposal from the Centers for Medicare and Medicaid Services would cut Medicare’s benefit reimbursement by 9.4 percent, causing an uproar by dialysis patients and their advocates.
“I am concerned that this cut will force some facilities to close and that other facilities will eliminate patient-focused programs, services, and benefits that improve patients’ health and quality of life,” Myers wrote to region lawmakers last month.
“I am writing to urge you to intervene with CMS to ensure that this proposed rule — when it does become law — is reasonable and protects my access to quality care,” he wrote to me.
Since becoming a dialysis patient, Myers has become a state advocate for the National Kidney Foundation, and an ambassador for Dialysis Patient Citizens and the Polycystic Kidney Disease Foundation. In other words, he’s a vocal activist on behalf of thousands of dialysis patients throughout Northwest Indiana.
In March, he traveled to Washington, D.C., and last week he met with U.S. Rep. Pete Visclosky to voice his concerns over the proposed budget cut, totaling a reported $970 million in 2014.
“These cuts threaten to close smaller rural clinics and this would undoubtedly affect this clinic in Crown Point,” he said while his blood filtered through a dialyzer. “If local facilities close or consolidate, my fellow patients and I will undoubtedly feel the effect. Many of them arrive here with canes, in a wheelchair, or in an ambulance.”
I contacted the Centers for Medicare and Medicaid Services, or CMS, and a spokeswoman shared with me a fact sheet explaining the complex methodology used to determine the budget cut proposal.
“The fact sheet explains the factors that adjusted the payments for end-stage renal disease, including provisions in the American Taxpayer Relief Act that directs CMS to adjust the payment bundle to reflect a decrease in the use of certain drugs and biological,” CMS spokeswoman Tami Holzman told me.
Based on 2007 claims, CMS’s detailed analysis showed an average payment per treatment of $83.76 for drugs and biologicals compared to 2012 claims reflecting a lesser payment, $51.42 for drugs and biologicals. In short, CMS subtracted the 2012 figure from the 2007 figure, resulting in a difference of $32.34.
“This amount is then reduced by the standardization, the 1 percent outlier, and the 98 percent budget neutrality adjustments, which results in an amount of $29.52,” the fact sheet states. This figure is then used to reduce the proposed 2014 base rate per treatment of $246.47, resulting in the budget cut proposal.
In 2011, CMS spent $10.1 billion on roughly 365,000 end-stage renal disease beneficiaries, according to the Government Accountability Office. And Medicare is expected to save nearly $5 billion over the next 10 years if the cut is approved.
Critics of the budget proposal say previous cuts by CMS, including a 2 percent reduction in payments in 2011 and the more recent sequestration cuts, are already taking their toll on dialysis patients and facilities.
“We are concerned that payment reductions risk reversing the progress that has been made toward increasing access to home dialysis,” states a letter to Congress by the Alliance for Home Dialysis.
“We are appalled by the CMS proposal to dramatically reduce Medicare funding for the care of dialysis patients, which will put at risk both patient access and quality of care,” stated one patient advocacy group, Dialysis Patient Citizens, in a prepared statement.
“Continued cuts may deter providers from opening additional facilities at a time when the number of ESRD patients continues to rapidly grow,” states one petition from the National Kidney Foundation.
“I speak on behalf of my clinic mates, who are too sick and unable to speak for themselves,” Myers told me. “I urge you to ask CMS and your lawmakers to revise its proposed rule so funding levels are adequate enough to cover the cost of dialysis care.”
If you think this issue doesn’t involve you, think again. More than 26 million Americans have chronic kidney disease — and that figure is growing each year — with diabetes the No. 1 cause. Plus, one in three Americans are expected to develop kidney disease so it could be any of us someday sitting in the same chair as Myers.
Myers has created an online petition for supporters to voice their opposition to the cut, here: https://www.change.org/petitions/center-for-medicaid-and-medicare-services-cms-withdraw-the-proposed-cuts-to-dialysis-centers-and-esrd-patients.
“It only takes a minute of your time and we only have until Aug. 30 to petition so the time to act is now,” he told me on my latest Casual Fridays radio show.
Listen to the entire interview with Myers at www.lakeshorepublicmedia.org. Visit www.post-trib.com to watch a video of Myers explaining his concerns and his crusade to challenge the proposed Medicare budget cut.
Connect with Jerry via email, at email@example.com, voice mail, at 713-7237, or Facebook, Twitter, and his blog, at jerrydavich.wordpress.com.