Dialysis patients cannot afford to be politically apathetic. Their lives could depend on using their voice to ensure that they have continued access to the medicines and therapies that allow them to continue being the mothers, fathers, caregivers, coworkers, and friends we love.
A rapidly changing healthcare landscape is erecting more challenges than ever for people who require ongoing intervention. It can be even more dangerous for the many Black people who need dialysis treatment. “It is no secret that health inequities and barriers to quality care contribute to adverse outcomes within America’s Black community,” wrote Dr. Walter L. Fields, Jr., in an op-ed he penned for the Milwaukee Community Journal.
Those barriers can cause those with kidney concerns to lack consistency where their care is concerned, sometimes even skipping hemodialysis sessions. The Journal of Kidney Medicine published a study that found “African Americans have a higher prevalence of kidney failure treated with dialysis and higher rates of nonadherence to hemodialysis, which are associated with excessive hospitalizations and increased financial costs.” According to a 2020 study by the Johns Hopkins Center for Health Equity, “Black Americans experience kidney failure at three times the rate of whites.” That same study asserted that “Many Black people lack access to diagnosis and treatment for chronic health issues.”
That creates a complicated climate for tackling kidney disease, according to the Johns Hopkins study, which confirmed that “Timing is critical for managing kidney disease, and Black Americans often aren’t diagnosed until the later stages of the condition, or even upon kidney failure, which makes the disease harder to treat and worsens the prognosis.”
Dr. Fields, the Senior Pastor of St. Paul Church of God in Christ MKE and the Superintendent of the Calvary District, has witnessed the devastation that can happen in households that do not get the proper support for their medical needs. He was so passionate about preserving access to certain therapies that he shared his views on upcoming policy changes that could impact his congregation and people nationwide.
“I take very seriously my role of caring for both the spiritual and physical health of my predominantly Black congregation, and my parishioners experience disparities in both health care and health outcomes,” said Dr. Fields.
“The Centers for Medicare and Medicaid Services (CMS) is now finalizing a policy change to be implemented in January 2025 that would severely limit dialysis patient access to certain medications, known as orally administered phosphate lowering therapies (PLTs). Dialysis patients take orally administered PLTs to manage hyperphosphatemia,” he continued. According to his op-ed, his interpretation of the change states, “The new CMS policy would prohibit PLTs from being paid for and provided under Medicare Part D and, instead, include PLTs into the bundled payment system for other dialysis services. The result: access to these essential medications at community pharmacies will be limited.”
According to their website, “On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2025.”
The site lists specific numbers and rates under a section labeled “Annual Update to the ESRD PPS Base Rate” to offer information to the public.
Fields considers the proposed rates to be insufficient. “This is a pre-set and often inadequate amount paid to the dialysis center to cover the cost of all services and therapies administered during dialysis. There is no question that this action by CMS would further worsen health inequities experienced by Black dialysis patients. It is well-known that dialysis centers are already underfunded and typically operate using one-size-fits-all protocols,” he wrote in his op-ed.
Legislation has been proposed to prevent this change in payment for PLTs and protect access to these important medications for patients with kidney issues. On July 28, 2023, Rep. Carter Earl L. Buddy introduced a bill, H.R.5074—Kidney PATIENT Act of 2023. The bill aims to “amend the American Taxpayer Relief Act of 2012 to delay implementation of the inclusion of oral-only ESRD-related drugs in the Medicare ESRD prospective payment system.”
Kidney Care Partners, which is a non-profit coalition representing 25 organizations including, patients, dialysis professionals, physicians, nurses, researchers, therapeutic innovators, transplant coordinators, and manufacturers expressed misgivings over the impact of the proposed change in policy in a release on their website. “KCP is concerned this policy may negatively impact patient access to care, as many dialysis providers lack sufficient infrastructure needed to dispense and administer these drugs,” they stated.
Dr. Fields believes that it will take the efforts of policymakers and private citizens to help the act become law before 2025 arrives. This need extends beyond his congregation and community.
The National Kidney Foundation reports that “1 in 3 adults in the U.S. are at risk for kidney disease.” Even more alarming information from the National Kidney Foundation states that “1 in 7 U.S. adults have kidney disease, and 90% don’t know it.” The sometimes silent progression of chronic kidney disease can limit the treatment options.
According to the Centers for Disease Control and Prevention (CDC), “Areas with the highest prevalence of diagnosed CKD (chronic kidney disease) are in Southern California, Florida, the Appalachian region, and the Midwest.”
A 2023 article in the American Journal of Kidney Diseases published the results of the REGARDS Study, which examined individuals from US states with a high burden of strokes, including Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. The study stated, “Established CKD risk factors accounted for higher risk of incident CKD in Black versus White individuals.”
Black communities are positioned to suffer from a lack of available care for kidney-related issues. If you want to use your voice to back the Kidney PATIENT Act, use the link below to contact your legislator.
https://www.votervoice.net/mobile/NMQF/Campaigns/117787/Respond
