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Dialysis Industry May Expand as Study Sways Medicare

Dialysis Industry May Expand as Study Sways Medicare
About 400,000 Americans undergo dialysis, a procedure using chemicals to remove toxic waste from patients. Photographer: Jay Directo/AFP/Getty Images

Nov. 24 (Bloomberg) -- A study concluding kidney patients can improve their health by undergoing twice as many dialysis sessions may prompt the U.S. government to reconsider Medicare rules restricting payments to DaVita Inc. and other providers.

Medicare, the health insurance program for senior citizens and the disabled, covers three sessions weekly unless more are shown to be medically necessary. An increase to six treatments may raise costs and require the dialysis industry to expand, said Alan Kliger, a clinical professor of medicine at Yale University in New Haven, Connecticut, and a study coauthor.

About 400,000 Americans undergo dialysis, a procedure using chemicals to remove toxic waste from the bodies of patients whose kidneys aren’t up to the task. While more treatment would increase spending on dialysis in outpatient facilities, overall care costs may fall if patients remain healthier, said LeAnne Zumwalt, a vice president at Denver-based DaVita, the largest supplier of dialysis services.

“It’s very good that we’re finally doing some studies that look at alternatives,” said Zumwalt, who handles public policy and regulatory issues, in a telephone interview.

DaVita rose 59 cents to $72.94 at 4 p.m. in New York Stock Exchange composite trading.

Peter T. Grauer, chairman of Bloomberg LP, the parent of Bloomberg News, is a DaVita director.

Treatment Cost

The cost of treating each patient with end-stage renal disease is about $75,000 to $100,000 a year, researchers said. Much of that expense comes from dialysis. The study was presented on Nov. 20 at the American Society of Nephrology meeting in Denver.

The findings, which were also published by the New England Journal of Medicine, may provide ammunition for the patient advocates and doctors who have been lobbying Congress to allow Medicare to reimburse routinely for four treatments a week rather than three, said Arthur Henderson, a Nashville, Tennessee-based analyst at Jefferies & Co.

“Getting reimbursement for four sessions has definitely been on the wish list,” Henderson said in a telephone interview. “The study might help those efforts, but there are immediate money pressures and not always immediate savings from these ideas.”

Dialysis will cost Medicare about $240 a session next year, Zumwalt said. At least 85 percent of dialysis patients are on Medicare and get on average 145 sessions annually, she said.

“More dialysis is better because when you’re on the Monday-Wednesday-Friday routine it’s hard to make it through the weekend,” said Lori Hartwell, a dialysis patient and founder of the Renal Support Network, in a telephone interview. The nonprofit advocacy organization is based in Glendale, California.

Less Heart Damage

For more than 40 years, patients suffering from advanced stages of kidney disease have received dialysis three times a week, for three to four hours a session, said Glenn Chertow, the study’s lead author and chief of nephrology at Stanford University School of Medicine, near Palo Alto, California.

In the study of 245 patients, about half received more-frequent dialysis, for 2.5 hours a session. Researchers found six treatments a week resulted in less damage to patients’ left-ventricular heart muscles, Chertow said in a telephone interview. That should “translate into better heart function,” he said.

While the trial was too small to conclude that more is better, it suggests that “our one-size-fits-all approach” needs to be reassessed, Chertow said.

Reimbursement Changes

It’s premature for Medicare, which is responsible for most spending on end-stage renal disease, to comment on the findings, said Ellen Griffith, a spokeswoman for the Baltimore-based Centers for Medicare and Medicaid Services.

Reimbursement is changing on Jan. 1, when Medicare switches to “bundled” payments, involving a flat fee for the treatment that may include associated services such as lab tests.

Expanding the number of Medicare-covered dialysis sessions may lead providers to add outpatient facilities and hire professionals to staff them, Yale’s Kliger said in a telephone interview.

“Capacity would definitely be an issue,” said Mike Klein, chief executive officer of Renal Advantage Inc., a closely held dialysis company in Brentwood, Tennessee.

Switching more patients to home dialysis may be one alternative, since the costs are less, with fewer facilities and personnel needed, he said in a telephone interview.

Peritoneal Dialysis

About 7 percent of home patients use a process called peritoneal dialysis, which relies on the abdominal lining to remove impurities with the help of a solution that is pumped into the belly area, according to the website of the Mayo Clinic, based in Rochester, Minnesota.

Another 2 percent do hemodialysis, in which toxins are filtered from the bloodstream, said Jeffrey Burbank, president and CEO NxStage Medical Inc. in Lawrence, Massachusetts. The company makes a portable hemodialysis machine used in home dialysis.

“There hasn’t been this quality of data before,” Burbank said. “I would hope this would have an influence.”

To contact the reporter on this story: Pat Wechsler in New York at pwechsler@bloomberg.net.

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net.

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