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Transplanting Too Soon

Nation's dialysis patients not informed about kidney transplantation

| Sunday, Oct. 4, 2009, 11:14 a.m.

The failure by some doctors to inform dialysis patients about kidney transplantation underscores the need to overhaul the health care system, lawmakers and experts said following an investigation the Tribune-Review published a week ago.

"You have pointed out the Achilles' heel of Medicare," said Rep. Tim Murphy, R-Upper St. Clair, a member of the House Energy and Commerce Committee, which is handling health care proposals in the House. "We have a system here that by design is not paying for the very thing we know saves money."

The newspaper series examined how nearly a third of the nation's dialysis patients are not informed about kidney transplantation, an option that is not only cheaper but can add years to their lives. A new kidney costs the federal Medicare program $50,000 less per patient than conventional dialysis, a debilitating treatment that forces patients to be hooked to machines for more than nine hours every week.

Lawmakers and industry experts said the investigation points to the importance of restraining costs and improving quality in the nation's health care system at a time when government leaders are debating ways to expand access to health care. They said the lack of kidney transplant information is just one example of problems that are rampant within the health care industry.

The Trib's series "highlights one of many deficiencies where Medicare is just not a modern, seamless system and it's not efficient," said Rep. Charles Boustany Jr., R-Louisiana, a medical doctor who specializes in cardiovascular care. Doctors need to do a better job of identifying patients who would benefit from receiving a transplanted kidney, and then making sure they get the information, he said.

"When I practiced medicine, I saw a number of patients with varying stages of renal failure," Boustany said. "I always questioned, 'Why hasn't this patient been referred for transplantation?' "

The cost of health care emerged as a concern during the months-long debate about overhauling the medical industry. Health insurance costs have outstripped inflation and wages for years, according to a report released last month by the Kaiser Family Foundation. Premium costs rose 131 percent since 1999, compared to 38-percent increases in wages and 28-percent in inflation.

Some Republicans, including Murphy, want to first fix problems with the existing private system, while many Democrats, such as Rep. Mike Doyle, D-Forest Hills, continue to call for a public option in which the government would operate an insurance program that would compete with private insurers. That would create competition and drive down costs throughout the industry, Doyle said. He also is a member of the Energy and Commerce Committee.

"If they have to compete and sharpen their pencils, that means everybody makes a little less money to be competitive," he said.

Another concern is the information provided to consumers who often rely on doctors and other providers to learn about their illness.

To that end, a Pittsburgh-based office that oversees treatment for patients with kidney failure arranged for a consultant to present a seminar on better ways for providers to talk with patients about the option of kidney transplantation, said Judy Stevenson, executive director of End-Stage Renal Disease Network 4, which oversees treatment for patients in Pennsylvania and Delaware.

"That's giving them a complete picture — this is the condition you have and these are the ways it can be treated," Stevenson said. "It allows them to make an informed decision. (The patient) can't do that if he doesn't have all the information."

A leading health care proposal in the House would provide money for community education programs that could better inform patients, Doyle said.

"To me, information to consumers is critical," he said. "We're trying to deal with a lot of these problems in the bill."

The proposals also would eliminate a Medicare provision that stops paying for kidney transplant recipients' immunosuppressive drugs three years after surgery. If the program saves money by helping patients receive a kidney, it should spend the money to help those patients keep the organ they receive, Doyle said.

Energy and Commerce Committee Chairman Henry Waxman, D-Calif., a leading proponent for a health care overhaul, agrees that any legislation should contain efforts to improve the quality of medical care and help patients make the best decisions for their health.

"For individuals who suffer from kidney disease, our bill has important reforms that will help by lifting the 36-month limit on immunosuppressive drugs," Waxman said. "This will reduce the odds of organ rejection among transplant recipients and will save lives and money in the long term."

Medicare last year created a rule requiring dialysis clinics to inform patients about options, but a top leader at the agency said checking for compliance would be too costly. That's unacceptable to Rep. Joe Sestak, who said Medicare should provide oversight and accountability.

"They've established a program, and it should be followed up with the oversight," said Sestak, a Democrat who will challenge Sen. Arlen Specter, D-Philadelphia, in the 2010 primary. "That should be business as normal with oversight, not business as normal without oversight."

Rep. Bill Cassidy, R-Louisiana, said the key is how the agency chooses to use the information.

"If you want to make a difference in this, and you're doing the audits, that information from those audits needs to be used to determine whether everybody is doing what they're supposed to be doing," said Cassidy, who is a medical doctor.

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