Medicare Comes Under Fire Over Dialysis Treatment; Draft Florida Policy Restricting Medication Is Criticized 1/29/2002
From: Spero Moutsatsos of the Florida Society of Nephrology, 813-251-1868 TAMPA, Fla., Jan. 29 -- Dozens of physicians, patient advocates and health care providers, including the president of the Florida Society of Nephrology (FSN), met with national Medicare officials to express concerns about policies affecting kidney dialysis patients. Among those speaking out was Dr. Carl Brueggemeyer, M.D., a nephrologist from Ponte Vedra who heads FSN. He said the open-door forum, held Jan. 18 at the Baltimore offices of the federal Centers for Medicare and Medicaid Services (CMS), showed that the renal community is alarmed by inconsistencies among local coverage policies. Dr. Brueggemeyer and others pointed out that under proposed Medicare policies, treatment for kidney dialysis patients could vary depending upon where they live. "Since physicians are trained under, and held legally responsible for, national standards of care, it is dangerous and illogical to use local Medicare policies to set treatment standards. That is another reason why patients and their physicians -- not arbitrary guidelines established by Medicare -- should determine what is the most medically appropriate treatment," Dr. Brueggemeyer said. In Florida, First Coast Service Options in Jacksonville, the insurance company that administers Medicare in the state, has proposed a policy that would restrict access to vitamin D therapies for secondary hyperparathyroidism, a dangerous condition associated with End Stage Renal Disease (ESRD). If not treated properly, the condition can cause weak or broken bones, heart problems, blocked blood vessels, anemia and weakness, nerve problems and reduced immunity. The draft policy would effectively prevent physicians from using an intravenous drug that is currently prescribed nationwide for more than three-quarters of patients requiring Vitamin D therapy. Dr. Brueggemeyer believes that the proposed policy "could have serious consequences for Florida's 16,000 dialysis patients. It would roll back the clock, forcing patients to return to an older method of care. It also would jeopardize a physician's ability to treat each patient as an individual." The Florida policy is opposed by a variety of national organizations, which have actively spoken out to express their concerns. Opponents include the American Medical Association, the PKD Foundation, the National Black Caucus of State Legislators and the National Medical Association, which represents African American physicians. The proposal would disproportionately affect African Americans in Florida, who account for 41 percent of the state's dialysis patients and are five times more likely than whites to be on dialysis. Nationwide, approximately 95 percent of dialysis patients who need Vitamin D therapy are treated intravenously. However, the draft policy proposed by First Coast would require Florida patients to be treated initially with oral therapy, which has been virtually abandoned by the renal community because of its lack of effectiveness. Only patients who "failed" oral therapy would be eligible for intravenous vitamin D therapy. And even then, Medicare would reimburse the cost of only the oldest drug, not the newer medication prescribed by most physicians. "This policy is unethical," said Dr. Brueggemeyer. "It turns patients into guinea pigs, forcing them to begin treatment with a medication that we already know -- from research and clinical experience -- is likely to be less effective than the current standard of care. And it is preposterous that patients should first have to 'fail' therapy with an older drug before they can be treated with a newer one. The medical consequences of that failure are an increased risk of serious or fatal side effects." The Florida Society of Nephrology, a statewide physicians' organization, represents doctors in the state of Florida who are dedicated to ensuring optimal care for patients with renal disease. For more information, visit our Web site at www.fsnonline.org. For additional information: Dr. Carl Brueggemeyer, M.D. Ponte Vedra, Fla. 904-273-5317 (for media use only; please do not publish) --- What Others Say Several national organizations are actively opposing efforts by Medicare intermediaries to impose restrictions on vitamin D treatment for dialysis patients: -- The American Medical Association approved a resolution on the Vitamin D issue at its annual convention in June 2001, saying: "Medicare is attempting to dictate the type of care patients receive from their physicians." The resolution called on Medicare to abandon the policy, saying "the practice of medicine must be left to the physician, and the making of medical decisions must be made by physicians in partnership with the patient and not by government entities." -- The PKD Foundation, an international organization devoted to improving clinical treatment and discovering a cure for polycystic kidney disease, went on record in May 2001 against such policies. "The PKD Foundation is very concerned that this policy could have a negative effect on patient outcomes," said Dan Larson, the foundation's president and CEO. -- The National Black Caucus of State Legislators approved a resolution in November 2001 saying such proposals "would set a dangerous precedent affecting all Medicare beneficiaries," and noting that African American patients, who make up about 12 percent of the U.S. population, yet account for 32 percent of patients with end stage renal disease, "will disproportionately suffer the harmful effect of this policy." -- The National Medical Association, which represents more than 25,000 African American physicians in the United States, wrote to the federal Centers for Medicare and Medicaid Services, which administers Medicare, in October 2001 to express opposition. "We believe this effort to force use of older, less effective medications to treat dialysis patients flies in the face of acceptable medical practice," said the association's chairman, Randall W. Maxey, M.D., Ph.D. "It also interferes with the right of physicians to prescribe the best available treatment for their patients. From my organization's perspective, we do not believe that Medicare should be trying to pinch pennies at the expense of African American patients, the group that would be most affected by this decision." --- For additional medical background: Joseph Webster, M.D. Affiliated with the Florida State Medical Association Founder of the Institute of African American Health Internist, Tallahassee 850-878-0471 Dr. Terence P. McCoy, M.D. Immediate Past President, Florida Medical Society 850-877-8171 Dr. Paul D. Seltzer, DO President, Florida Osteopathic Medical Association West Palm Beach 561-848-0330 or Steve Winn, FOMA executive director, Tallahassee 850-878-7364 Dr. Robert Geronemus, M.D. Florida Society of Nephrology Nephrologist, Lauderdale Lakes Office: 954-739-0897 |