"No" to the Proposed Medicare Cuts on Dialysis

My blog post this week is about the proposal by the Centers for Medicare and Medicaid Services (CMS) that would cut Medicare reimbursement for dialysis. I am very concerned about these proposed cuts, and how it would impact my friends at the dialysis center. According to one of the articles that I’ve read, these cuts would reduce the reimbursement rate by 10% to almost $20 per dialysis session. Medicare reimbursement already does not cover the cost of dialysis. At three days a week at about four to five weeks per month, that would be at least an additional expense $240 per month.

If I were still undergoing dialysis treatments, these cuts would probably not make significant difference for me. Thanks to my employer, I have excellent health insurance. Since I had been on dialysis for some four years, I did rely on Medicare to pay for 80% of my dialysis treatments. Since the rest was paid for my insurance, I have had minimal costs per treatment and for that, I feel fortunate. However, I am probably in the minority.

I am thinking of the other patients in the center who completely rely on Medicare to pay for their treatments. For someone with a fixed income or are unemployed, an additional $240 per month would be a significant strain on their budget. People on a fixed income already have a difficult time ‘making ends meet.’

I am thinking specifically of the lady who usually sat across from me. I believe her name is Lupe. She is an older lady, and usually has a hard time when she was having treatments.  She did not speak English; so we rarely had a conversation (I am not that conversant in Spanish either).

Lupe had to stop working because her dialysis treatments were making her very exhausted. For extra money (probably really to make ends meet), she made and sold tamales. Making tamales probably also kept her mind off dialysis and her kidney disease. She would sell tamales in the center, and the technicians loved it. They would order 10 at a time and different flavors (she sells them for $1.50 each). I actually had two of them, and they were absolutely delicious.

I cannot imagine what might happen to Lupe if these cuts are implemented. An additional $240 per month would be hard on someone who is unemployed. This may mean that she has to cut on food or worse, on prescription drugs and even on some dialysis treatments.

And it is just not Lupe, it is also Jerry, who has to continue dialysis because he is considered too old and too ill; the Chinese lady who did not seem to have any family who would take care of her, and my husband’s buddy and fellow Pittsburg Steelers fan, who has to keep on working because he has a family to help take care of. Multiply this number with the number of dialysis centers all over the country and there would be thousands of very good people affected.

Dialysis patients are suffering enough - we need to support them as much as possible. As the petition states, “We urge the Administration and Congress to ensure that Medicare reimbursement for dialysis is sufficient to cover the cost of care.” Please contact your local representative through the National Kidney Foundation's Take Action Network.

It is the humane and compassionate thing to do!

Flashbacks

Last week, one of my friends at work asked me a question about dialysis. Her husband, unfortunately, has to start dialysis soon, and they were hoping that they could postpone starting dialysis for another month. Their reason for postponing was not frivolous (and personal that is why I am not sharing it in this post), so I understood why they are thinking of delaying the inevitable. 

We had a brief, but good chat about dialysis, and I was glad to share my experience. It looks like I answered her question and gave her some good tips. At the end, she said her husband is trying his best to maintain the little kidney function that he has.

I mentioned to her that I was in a similar position when I was diagnosed and had to watch my diet closely. Although I did not share this with her, I remembered that my husband and I tried to keep my kidney function up, primarily through diet. I did have to watch my diet like a hawk to keep it from falling completely. I ate very little protein per day: only four ounces, if I remember correctly. I had to give up my favorite soy chai lattes and had to be very creative with meals. Most days, I was having no protein for breakfast, two ounces for lunch and two ounces for dinner, or some combination of thereof.  My meals were mostly carbs and vegetables. It was not the good, high fiber carbs either; it was white bread, white rice, white flour – ugh! No more brown rice, Wheaties, or multigrain muffins. I was lucky to be Asian and having white rice as a staple in our diet. My favorite meal was usually breakfast when I can have muffins! I figured since I am watching everything, I can have some sugar twice a week. Occasionally, I can have an egg for breakfast since that was considered one ounce.

I was fortunate back then; I was still peeing so I did not have any fluid restrictions. I think that was one of my treats. Since I was suffering from gout, I was drinking black cherry juice. I would have that with some of my meals, but dilute it with water and ice (black cherry juice was a bit too sweet for me).  I even considered making a faux-sangria with it by adding apples and oranges (did not attempt to do so though – not the same without wine). Speaking of sangria, I had to limit my alcohol intake. I probably just limited it to one glass of wine (or sangria) per week, if any. Yes, I became an inexpensive date (not cheap, though).

My diet back then was very restrictive. I kept (and am still keeping) a food diary so I can keep track of my intake and things that trigger my gout attacks. I can imagine that this would be trying to anyone especially if you have a “meat and potatoes diet”. I was able to stay out of dialysis for a year. During this period, my husband and I were very thankful for every .01 increase in my GFR (Glomerular filtration rate - a measure of how well the kidneys are working).

I hope all goes well with my friend and her husband. They have a lovely family and their young kids would need Dad around for a long time. I wished them well and offered my advice anytime she needs it. Been there and doing my best to give back… and not to be there again.