As many of you know, I have been advocating against the proposed cuts to Medicare payments to dialysis centers and in turn the affect this has in all in center patients, including both Medicare patients as well as private insurance patients.  Obviously a reduction in payments to centers could result in a cutting of services, a layoff of valuable dialysis employees like techs, nurses and social workers, the possible closing of centers, and the shuffling and relocation of dialysis patients to different centers.  There has also been expressed that dialysis on demand may be in jeopardy as a possible return to dialysis by committee selection.  Most of my in center dialysis friends have gotten the message and are taking steps to make their objections known.  Where some resistance in the dialysis community remains is with people that take dialysis at home, either home hemo or peritoneal dialysis.


          The general remark that is made is that since the cuts do not affect home dialysis patients, this is not our fight.  I wrote the Dialysis Patient Citizens asking if these cuts affect home dialysis patients and here is the response I received:




December 3, 2012  


Dear Member of Congress: 


As you consider solutions to address the economic challenges facing the country, the Alliance for Home Dialysis urges you to protect Medicare beneficiaries’ access to home dialysis by refraining from making any additional payment reductions to the Medicare End Stage Renal Disease (ESRD) Prospective Payment for dialysis. 


The Alliance for Home Dialysis is a coalition of kidney dialysis stakeholders, representing patients, clinicians, providers and industry, that have come together to promote activities and policies that will facilitate treatment choice in dialysis care while addressing systematic barriers that limit access for patients and their families to the many benefits of home dialysis.  Congress has long recognized the importance of ensuring beneficiaries have access to a choice of modalities, which include peritoneal dialysis (PD) and home hemodialysis (HHD), because they offer  some patients significant quality of life advantages, including clinically meaningful improvements in physical and mental health.  


The Alliance is concerned that reductions to the ESRD Prospective Payment System (PPS) could jeopardize Medicare beneficiaries’ access to home dialysis. (Emphasis added).  The implementation of the new ESRD bundled payment—the first value-based purchasing program under Medicare—has been successful in making progress towards one of its stated goals i.e., to “encourage patient access to home dialysis” 1 and to “make home dialysis economically feasible and available to the ESRD patient population.” 2  Today, only about 10% of U.S. dialysis patients receive treatment at home.  Yet, the most recent annual survey of the ten largest providers found that between 2010-2012 home patients represented about 20% of the growth in ESRD patients. This is significant given that in years prior there had been little growth in home dialysis.  


We are concerned that payment reductions risk reversing the progress that has been made toward increasing access to home dialysis, as facilities may not be able to invest in the development and ongoing management of home dialysis programs .  Dialysis facilities were already subject to a two percent payment reduction under the new bundled payment and are facing a two percent cut through sequestration next year. Because nearly 80% of dialysis patients are Medicare beneficiaries, facilities do not have the same ability to spread costs to other payers as broadly as other Medicare providers. Most importantly, the ESRD PPS system is still in its infancy, with full implementation not taking effect until 2014. More experience with the system is necessary to understand the full impact of the program before any fundamental changes are made. (Emphasis added).


                                                 1 75 Fed. Reg. 49,030, 49,058 (Aug. 12, 2010). 2 Id . at 49,060.


Congress should maintain its commitment to the approximately 400,000 Americans on kidney dialysis by preserving current payment rates and ensuring continued access to home dialysis.  (Emphasis added).


If you have any questions or need additional information, please contact Lindsay Punzenberger at or 202-466-4721.  For a list of organizations participating in the Alliance’s working groups, please visit our website at .    




Stephanie Silverman Director”   


          In other word, the Home Dialysis Alliance fears these cuts like the proposed cuts by the CMS will have an effect on both their Medicare patients and programs for home dialysis, which are sponsored by dialysis centers like Fresenius and DaVita.   As I am reading this response, if you, your loved one, friends or family are on home dialysis, these cuts affect you, too.


Please sign and share this petition:


To write a short form letter, go here:


To make a scripted call to your Congressperson/Senators, go here:







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