The kidney care sector across the nation is grappling with numerous challenges that are straining resources and compromising patient access to care. A growing workforce shortage among dialysis providers and nephrology registered nurses (RNs), high burnout rates, an ageing workforce, and the economic fallout of the pandemic are all contributing to the critical situation faced by kidney care professionals. Furthermore, the low reimbursement rates specified in the End-Stage Renal Disease (ESRD) payment final rule are set to exacerbate an already fragile care system.
Simultaneously, the demand for dialysis services is on the rise. Chronic kidney disease (CKD), the fastest-growing noncommunicable disease in the country, currently affects nearly 40 million American adults. If CKD progresses to kidney failure or ESRD, individuals must undergo regular dialysis treatments or receive a kidney transplant to survive. With the population of individuals with kidney disease growing by an estimated 5% to 7% each year, dialysis clinics will remain a crucial part of our nation’s kidney care infrastructure.
The dangerous combination of a healthcare professional shortage and an escalating demand for care is already impacting dialysis clinics nationwide. Workforce shortages are forcing clinics to reduce shifts or even shut down completely, often in rural or medically underserved areas. Despite this, the CMS’ payment increase is significantly lower than the rising costs, especially the high labour costs for specialized nephrology RNs and other personnel who are essential in delivering high-quality, timely, and life-sustaining kidney care. Since Medicare is the payer for nearly 80% of all dialysis patients, when Medicare fails to adequately address costs, there is very little backstop of other payers to support the system until Medicare catches up.
The discrepancy between the cost increases dialysis providers are facing and what CMS is reimbursing them is directly and negatively affecting the ability of dialysis providers to adequately staff their clinics, ultimately impacting access to care. There has been a significant loss of experienced staff and mentors, making it very difficult to foster the growth of new staff who are just learning this speciality and the unique needs of individuals on dialysis. Maintaining safety and quality is becoming more challenging as the focus of care is strained and limited to basic task completion.
These labour challenges will be particularly devastating to medically underserved rural and urban communities, forcing patients to travel hours for care because their local clinic has closed.
In the face of these challenges, CMS has failed to address the fact that its own assumptions used to set the annual payment update have been incorrect in recent years. We also encourage Congress to pass the necessary legislation to address these issues. The kidney care community is in dire need of support and solutions to these pressing problems.
