From Shad Ireland, athlete and advocate living with kidney disease.
As an accomplished athlete who has successfully lived on kidney dialysis for almost three decades, and one of the leading advocates for the renal community, I find myself in a position where I need to issue a statement publicly about a decision currently being considered for implementation by CMS that will adversely impact the renal community and increase our long term Medicare costs significantly. I must respectfully insist that CMS reinstate the sub-10 hemoglobin metric as part of the QIP.
There are currently 600,000 Americans on kidney dialysis with an additional 25 million Americans living with CKD, Chronic Kidney Disease. Another 21 million Americans have the disease, and they are walking around unaware that their kidneys are failing! Kidney Disease is significantly growing in the United States due to the increase of obesity, high blood pressure, and diabetes. There are over 133 million Americans who are considered obese or overweight, with an additional 54 million Americans predisposed to developing Type II diabetes, and millions of Americans who have undiagnosed and or untreated high blood pressure.
The financial impact of this disease on our society is significant and the tough decisions we are left to make require us to take pause, and reconsider our approach as to how we have traditionally delivered healthcare in this country. We have a reactionary approach to delivering care yet we struggle to understand that this is systemically a chronic issue.
I recently read an article in the USA Today written by Rita Rubin where she quotes Barry Straube, chief medical officer at the federal Centers for Medicare & Medicaid Services, “25 million Americans have kidney disease, but Medicare benefits don’t kick in until patients are at the most advanced stage. Many patients with earlier-stage kidney disease aren’t treated for high blood pressure or diabetes, which cause two-thirds of kidney failures.” The article goes on to quote other distinguished and respected individuals within the renal community, J. Michael Lazarus, Fresenius’ chief medical officer, says: “Every nephrologist would love to see patients earlier. But nobody sends them. … I’ve seen them in the emergency room at the end. That’s because many rarely have seen any kind of doctor, let alone a kidney specialist.”
The article began with the following statement, which lends support to my point; The End Stage Renal Disease Program doesn’t address prevention, a major focus of the health care debate.
The key to cost reduction is patient stabilization. This can be achieved through patient education, awareness & prevention, and access to first line therapies and first line medications. The invention and use of ESA’S saved the lives of hundreds of thousands of patients including mine. It has given me the ability to successfully live with this disease because it is a part of my healthcare team’s overall medical treatment approach to stabilizing my disease. When hemoglobin is kept within the recommended 10-12 g/dl target range the patient’s anemia stabilizes to a point where they feel better and have the energy to start the long road back to rebuilding a stable and successful life with kidney disease.
One point I would like to make is that the amount of ESA I require has gone down over the years as my health has stabilized. I attribute that specifically to the combination of great anemia management and cardiovascular exercise. One of the many benefits I have seen is the reduction of hospitalizations I have experienced. (Only three times in the past nine years) People given a renal diagnosis, especially those on dialysis, can on average expect to be hospitalized 4 to 6 times per year totaling 15 days. Arguably, the costs of hospitalizations far outweigh the costs of providing first line therapies and first line medications to kidney disease patients. Should we not be focused on the true culprit?
By removing the sub10 hemoglobin metric and not reinstating it as part of the QIP we can and will see the following:
- An increase in the use of blood transfusions
- A decrease in eligible transplant patients due to blood sensitivity
- An immediate change in the stabilization of the disease
- Decreased anemia management
- An increase in co-morbid conditions due to the sedentary activity levels of patients given a renal diagnosis
- Unnecessary and extraordinary burden will be placed upon the health care eco-system (Patient/Physician/Provider) as this singular cost savings approach becomes the driving factor
Sometimes we are unable to see the forest for the trees. More and more often we find ourselves “reacting” to the national healthcare situation that presents itself. Our problems stem from the fact that we are all symptomatic to the disease, NOT the therapy. We have a responsibility to the stewardship of our healthcare dollars and the broadest possible impact those dollars can have in the delivery of life saving therapies. Without the sub-10 hemoglobin metric being reinstated as part of the QIP I am afraid that we will lose any chance of stabilizing one of the major co-morbid conditions (anemia) and ultimately the disease itself. The results will be catastrophic, as this singular approach to better managing our healthcare dollars will ultimately deliver a significant increase in Medicare expenditures.
I was left to draw on my extensive personal experiences before the invention of ESA’S while I considered both sides of the debate. I remember having to live with a hemoglobin below 10g/dl and the magnitude of blood transfusions it took to keep me alive and barely functional. These experiences have led me and my organization to take the following position regarding this issue; the sub-10 hemoglobin metric needs to be reinstated as part of the QIP.
Sincerely,
Shad Ireland- Executive Director
Shad Ireland Foundation- Impact Focused, Technology Driven
www.shadirelandfoundation.org