Dozens of Utah kidney dialysis patients got a much-needed Christmas present with a federal judge's preliminary order halting planned Medicare reimbursement cuts for home dialysis services.
U.S. District Judge Stanley Sporkin in Fort Lauderdale, Fla., ruled last week that the proposed 48 percent cut must wait until he makes a final ruling on a lawsuit filed by North Miami Beach-based Home Intensive Care.The judge's order came after two days of hearings on a suit brought by Home Intensive against Blue Cross and the U.S. Health Care Financing Administration, which administers the Medicare program.
Sporkin did not say when he would issue a final ruling, but the preliminary injunction will enable patients nationwide to continue receiving home care at reimbursement rates originally approved by Medicare.
Utah health care officials called Sporkin's decision an important landmark for the more than 100,000 Americans, including several hundred Utahns, who suffer from kidney failure.
"This is a wonderful celebration for the New Year for kidney patients here in Utah," said Deen Vetterli, executive director of the National Kidney Foundation of Utah. "We have had some grave concerns (about Medicare) here in Utah and have written some letters to Health Secretary Otis Bowen to let him know of our concerns.
"It sounds like whom ever we have been talking with has gotten through to the right people."
Since 1972, the federal government has provided care to all victims of kidney failure. Most patients receive dialysis - thrice weekly treatments in which the blood is pumped through a filtering system to remove deadly poisons and excess fluids. However, the federal Department of Health and Human Services recently announced that government auditors are about to begin a wide-ranging review of their program. In the audit, expected to take several months, they will be evaluating everything from the practice of cleansing and reusing disposable dialysis equipment, to charges by different clinics, to home dialysis treatment.
Currently between 50 and 135 Utah kidney patients are receiving dialysis at home.
A few years ago their personal expenses were reduced by an experimental federal program in which Blue Cross Blue Shield of Utah, which processes the Medicare claims, participated.
Jeri McGeeham, director of Medicare A for Blue Cross Blue Shield, said through the special program, Medicare not only purchased the dialysis machines, but paid for a technician to help the patient operate them.
That program, however, was discontinued two years ago. Today, Medicare pays for the dialysis equipment and supplies.
The patient, McGeeham said, pays an annual $75 deductible and a 20 percent co-payment. The patient must also pay for the services of a technician, if a family member is not available to help operate the machine.
"If the 48 percent cut went through, it would add to the patients' out-of-pocket expenses," McGeeham said. "It puzzles me that they would be cutting back on the dialysis patient, but there are so many things going on in Congress that we don't know about until they are finalized."
Rod L. Betit, director of Health Care Financing for the Utah Department of Health, hopes the cuts are never finalized. A decrease in the Medicare reimbursement, he said, could spill over into Medicaid. "And we don't have any extra money there."
For some time, officers of the non-profit National Kidney Foundation of Utah, have been working with federal officials to resolve inequities in the amount of Medicare disbursements to Utah kidney patients as compared to those in surrounding states.
Early in December at a well-attended testimonial dinner, the foundation also honored Sen. Orrin Hatch, R-Utah, for his efforts in furthering funding for immunosuppressive drugs; his strong commitment to national biomedical research and his continuing advocacy of health care services in the home.
Vetterli hopes the judge's preliminary ruling means other people are also listening to the concerns of kidney patients who benefit from home health care.
"Not only are they in the comfortable setting of their own home, but it provides them with a tremendous amount of freedom and flexibility," she said.
Plus, Vetterli said patients treated at home don't have to worry about expensive and inconvenient transportation to and from Utah's 15 dialysis centers.
"For the patients who want to have dialysis at home, the judge's preliminary ruling is wonderful news," she said.