Dr. Beth Piraino, NKF President
Currently dialysis patients who have a terminal illness that is unrelated to their kidney failure can choose to enter hospice care and still receive dialysis paid for by Medicare. However, under a proposal by the Centers for Medicare & Medicaid Services (CMS), this policy could change. That’s because CMS is proposing to expand the definitions for terminal illness and related care, which could effectively require hospice providers to pay for dialysis under their current payment even when the patient may be dying of another condition or disease unrelated to their kidney failure. However, the Medicare payment for Hospice is not enough to cover dialysis treatments in addition to other treatments terminally ill patients need. Therefore, it is unlikely that most hospice providers will cover dialysis care, leaving patients and their families to choose between giving up dialysis and entering hospice or continuing to dialyze, but give up the supportive care and psychological benefits that hospice providers deliver.
A recent study published in the American Journal of Kidney Disease highlights the difficulty patients and families experience when faced with the decision to withdraw from dialysis. The article also suggests that differences in decision making for withdrawing from dialysis may also be attributed to cultural beliefs and customs. This study is an example of how dialysis patients could benefit from the psychological support that hospice care can provide to patients and their families.
In comments to CMS on this proposal, NKF stated that dialysis patients should receive an exception from the CMS proposal and be allowed to have Medicare pay separately for dialysis treatment and hospice care. Doing so would provide the patient with a terminal illness with access to hospice benefits while also continuing to receive dialysis. End of life decisions are not easy for anyone involved, and CMS should not be implementing payment policies that force a patient to suffer unnecessarily.