||Articles from Nephrology News & Issues:
Editor's note: Finally! The first articles about dialysis patient employment in years!
Unfortunately, we have to start from almost nothing. There has been almost no work or research in this field. CMS policies do nothing to encourage patient employment. There is essentially no rehabilitation and/or employment expertise in the two junk-credit-rating, for-profit corporations that dominate U.S. dialysis care. These corporations have no financial incentive to increase patient employment. The patient advocacy groups have never accumulated or prioritized relevant data from patients, nor have they formulated any policy requests that would increase patient employment. The American Society of Nephrology has not advocated patient employment as a treatment goal. The new chair of Kidney Care Partners, Dr. Franklin Maddux, has never mentioned rehabilitation or employment in his four years as Chief Medical Officer at Fresenius Medical Care.
Even patient advocates like Dori Schatell and Peter Laird have written against targeting patient employment as a treatment goal. What they fail to appreciate is that targeting increasing employment rates, year after year, decade after decade, will continually improve dialysis care and technology for all. Failing to target this high-level goal for this important subpopulation has created a system of for-profit care that condemns nearly all patients to enslavement to a life called dialysis.
Yes, we need to get to work, but what can unite the dialysis corporations, CMS, legislators, nephrologists,
patient groups, and advocates with their own agendas?
The likely best solution is to extend the Medicare Secondary Payer (MSP) period for employed patients. If more patients stayed employed, dialysis clinic revenues would increase. That would incentivize the corporations and their nephrologists without increasing government spending. Patient needs and concerns would be heard. It would also drive the improvements in dialysis technology that have been sorely needed.
But what will likely happen? Unfortunately, there are tremendous institutional inertias. A committee of stake holders will eventually be formed that will, after one or two years, finally release a statement calling for... additional studies. Who benefits from this outcome? The junk-bond dialysis corporations, all the organizations they support, and the politicians that depend on their campaign contributions.
Many fields of U.S. medicine have successfully harnessed the power of profit incentives for the benefit of patients. Unfortunately, largely because of the Stark Law exemption for nephrologists, U.S. dialysis care is the poster child for the failures of for-profit medicine.