Challenges in Renal Care

In 2006, all major U.S. dialysis providers were facing a daunting set of challenges. Having survived a period of intense consolidation and ever-diminishing operating margins, they were now struggling to understand what lay ahead. With more than 80 percent of their patients covered by Medicare’s End-Stage Renal Disease (ESRD) program and with Medicare reimbursement barely covering costs, these providers increasingly relied on additional reimbursement for certain injectable drugs, as well as on the small percentage of patients with private insurance, for financial viability. However, both of these sources of profitability were coming under pressure. Ongoing demonstration projects by the Center for Medicare and Medicaid Services (CMS) were opening the way for dramatic changes in the reimbursement landscape, and private payers were becoming more restrictive regarding what they would pay for and how much they would pay. These actions by CMS and private payers were sure to have far-reaching implications for patients, providers, and the ESRD program as a whole. Change was imminent and the uncertainty facing providers was creating significant challenges.