Medicare Reimbursement and Other Barriers to Home Treatments

Regular dialysis treatments are a life-saving necessity for patients with End Stage Renal Disease (ESRD), and the prospect of discontinuation of dialysis with a diagnosis of ESRD remains very low. The leading causes of kidney failure necessitating dialysis are diabetes and high blood pressure, accounting for about 70% of cases.

Recent statistics reveal there are currently more than 500,000 patients undergoing dialysis treatment in the United States. Roughly 45% of dialysis patients are women, while 55% are men. The average age of patients receiving dialysis is around 64 years old. 

There are two main types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis is the most common, used by about 90% of dialysis patients. Most dialysis patients receive treatments three times per week, with each session lasting about 3-4 hours.

Sadly, the annual mortality rate for dialysis patients is high, with around 20% of patients dying each year. The five-year survival rate is approximately 35-40%. Unfortunately, dialysis is also expensive, with annual costs averaging about $90,000 per patient. The lengthy, repetitive treatments can also take a toll — physically and psychologically — which can further complicate matters. 

Often, patients feel most comfortable with home treatments because they have to sit for long periods of time on a continual basis. In fact, home dialysis treatments have increased over the past decade, and it is estimated that the U.S. home infusion market will reach $20.6 billion by 2027.

When to Recommend Home Treatments for Dialysis Patients

But when should you recommend home treatments to your dialysis patients? It depends on several factors that can influence their overall health and quality of life. Here are some key considerations:

Medical Stability: Patients whose conditions are well-managed and stable may be good candidates for home dialysis. Patients should have no severe or frequent complications that require immediate medical attention.

Patient Capability: Patients must be able to understand and manage their dialysis treatment independently or with the help of a caregiver. Patients should be willing and able to undergo the necessary training to perform dialysis at home.

Support System: A reliable caregiver should be available to assist if needed. The home should have a clean, dedicated, safe space to conduct dialysis

Patient Preference: Many patients prefer home dialysis for the quality of life and the flexibility it offers in scheduling. Patients who feel more comfortable and secure in their own homes may also benefit psychologically from home treatments.

Resource Availability: Ensure patients have reliable access to the necessary equipment and supplies. There should be a clear plan for handling emergencies, including quick access to professional medical help.

Patient Health Goals: Evaluate whether home dialysis aligns with the patient’s long-term health goals and treatment plans. Schedule regular monitoring and follow-up to track the patient’s health and address any issues promptly.

Implementation Steps for Choosing Home Dialysis Treatments

By taking these factors into account, healthcare providers can make informed decisions about recommending home treatments to dialysis patients, ensuring safety and improving their quality of life.

A typical implementation plan would look something like this: 

1. Initial Assessment: Conduct a thorough assessment of the patient’s health, home environment, and support system.
2. Education and Training: Provide comprehensive training for the patient and caregiver, if applicable.
3. Trial Period: Consider a trial period to evaluate the patient’s comfort and capability with home dialysis.
4. Regular Check-ins: Schedule regular follow-up visits and provide easy access to support resources.

Another important consideration when thinking about home treatments are the patient’s insurance coverage and financial situation. Confirm that the patient’s insurance policy covers home dialysis treatments. Consider the financial implications for the patient and discuss potential cost savings or additional expenses.

Insurance Coverage and Cost Considerations for Home Treatments

In the United States, Medicare typically covers about 80% of the cost of dialysis treatment. It also covers home infusion therapy services needed to safely administer certain intravenous or subcutaneous drugs in a patient’s home, like nursing visits, caregiver training, and patient monitoring.

However, Medicare reimbursement policies can influence patients’ ability to receive home treatments. While Medicare generally covers home dialysis and infusion therapy, reimbursement rates and eligibility criteria may vary, potentially posing financial barriers for some patients. 

Additionally, other obstacles to receiving equitable home care may include:

• Availability of Services: Home dialysis and infusion therapy may not be readily available in all geographical areas, particularly in rural or underserved regions where healthcare infrastructure is limited.
• Cost Considerations: While Medicare may cover a portion of home treatment costs, patients may still incur out-of-pocket expenses for equipment, supplies, and additional services not covered by insurance. Cost considerations can be a significant barrier, especially for individuals with limited financial resources.
• Accessibility and Infrastructure: Home treatments require adequate infrastructure and support systems, including access to reliable electricity, clean water, and storage space for medical supplies. Patients living in unstable housing or lacking necessary amenities may face challenges in setting up home treatment environments.
• Physician Training and Support: Healthcare providers need specialized training to facilitate home treatments effectively. Limited physician knowledge or experience with home dialysis or infusion therapy may hinder patient access to these services. Increasing physician education and support can help overcome this barrier and promote the adoption of home-based care options.

Addressing these barriers requires a multi-faceted approach involving policy changes, financial support mechanisms, infrastructure development, and healthcare provider training to ensure equitable access to home-based treatments for all eligible patients.

At Home or in a Clinic, Dialysis Patients Deserve Comfort

Because most dialysis patients receive treatments three times per week, with each session lasting about 3-4 hours, sitting in one spot for that long can be very uncomfortable and even distressing. That’s where Champion can help.

Champion’s Classic recliner, commonly used in dialysis settings, features infinite recline positions and either stationary or swing-away arms to provide optimal patient comfort and better access for caregivers. With fold-away tables, foot trays and quick-release seats, caregivers get more versatility and convenience from the Classic. 

Take advantage of today’s short lead time when replacing aged recliners and opt for the dialysis treatment chair that’s been preferred for more than 30 years. Contact Champion today.

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