A call for quality, accessible care for people living with kidney disease | Viewpoint

As someone who has personally navigated the challenges of kidney disease for most of my life – including kidney failure, dialysis, and multiple transplants – I understand firsthand the importance of access to quality healthcare.

Lori Hartwell

My lifelong journey, coupled with my role as the founder and CEO of the Renal Support Network (RSN), has afforded me insights into the myriad of struggles faced by people on dialysis.

Most recently, we are tracking an emerging issue from recent years concerning enrollment in Medicare Advantage (MA) plans.

MA offers a lifeline for many people who have kidney failure, providing an alternative for those without access to other insurance options. However, despite its potential benefits, there are significant deficiencies within the MA system that must be addressed to adequately serve the needs of people living with kidney disease.

One of the foremost concerns is the issue of dialysis “network adequacy” and transparency. It is imperative that MA plans include access to a sufficient number of dialysis facilities, nephrologists, and other specialists needed for quality kidney care.

CMS decisions to exclude dialysis facilities from time, distance, and other network adequacy requirements plans must meet have only exacerbated challenges, leaving people living with kidney disease at risk of disruptions in care.

The prospect of having to switch facilities or transplant centers due to network limitations not only induces stress but also compromises the continuity and quality of care. The cascade of these access issues can also result in longer travel distances for care and inconvenient dialysis times that greatly disrupt people’s personal and professional lives.

The lack of transparency regarding network adequacy changes poses additional hurdles, particularly for those waiting for kidney transplants.

The uncertainty surrounding sometimes abrupt network alterations can delay the transplant processes, leaving patients in limbo and impeding their access to life-saving kidney transplants. MA plans must provide clear and accessible real-time information about network changes and their potential impact on access to care.

It’s crucial the collection and reporting of Medicare Advantage data be standardized to ensure meaningful comparisons and informed decision-making. Both patients and healthcare professionals rely on accurate data to assess the quality of care provided by MA plans. Any discrepancies or inconsistencies in data collection undermine the integrity of the system and hinder efforts to improve patient outcomes.

Also, there is a pressing need to address disparities in the level of care between MA plans and traditional Medicare fee-for-service. People on dialysis should not have to compromise their health because of limitations imposed by their MA plan. Equal access to treatments and medications is essential to ensure that everyone receives the quality care they deserve.

Finally – and most concerningly – some MA plans entice patients into enrolling, promising benefits that, in reality, may not materialize. These practices jeopardize patient well-being and erode trust in the healthcare system. I appreciate the steps CMS has taken to finalize policies in this year’s MA rule-making that crack down on such tactics.

Addressing the deficiencies within Medicare Advantage is paramount to ensuring access to care for people living with kidney disease. By advocating for network adequacy, transparency, standardized data collection, and equal treatment across all healthcare plans, we can empower all Americans living with kidney disease to make informed decisions about their health and well-being.

Together, we can work towards a healthcare system that ensures access to care, options for innovation, and fosters hope in the face of chronic illness.

Lori Hartwell is the founder and CEO of the Renal Support Network.