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Joined: 11 Jan 2003
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Posted: 30 Sep 2009 01:16 Post subject: Many on debilitating dialysis not told about transplantation
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Many on debilitating dialysis not told about transplantation option
By Andrew Conte and Luis Fabregas
TRIBUNE REVIEW
Sunday, September 27, 2009
The failure of doctors at dialysis clinics to inform thousands of patients about kidney transplantation may be shortening lives and costing taxpayers millions of dollars a year, a Tribune-Review investigation found.
Kidney transplantation adds an average of 10 years to a patient's life, and a new kidney costs the federal Medicare program $50,000 less per patient than conventional dialysis.
Yet, thousands of patients started dialysis without hearing about transplant options. Some spend as long as five years on the debilitating treatments before they are placed on the nation's transplant wait list, while others who would benefit from the surgery are not even on the list.
Those spending a year or longer on dialysis before being listed for a transplant include privately insured patients whose treatments are more profitable to clinics. The country's largest dialysis providers say they need those patients to offset lower payments from Medicare.
Money plays a strong role when it comes to prescribing dialysis before transplantation, some experts say. Others point to ignorance, fear and insurance rules as reasons dialysis patients are not listed for transplantation.
"In the ideal world, were money not an issue and if everyone was honest, everyone would be referred for a transplant right away," said Dr. Bruce Kaplan, chief of nephrology and medical director of the Abdominal Transplant Program at the University of Arizona Medical Center.
Given the magnitude of the problem, many factors can contribute to the lack of transplant referrals, said Dr. Herwig-Ulf Meier-Kriesche, medical director of Renal Transplant at the University of Florida's Department of Medicine.
"Certainly, the data can't really tell you why all this is happening," he said. "We just know that a lot of patients who should be referred are not, but there might be good reasons for it."
The dominance of dialysis over other kidney disease treatments occurs at a time when lawmakers are engaged in a fierce debate over how to restrain soaring health care spending. Patients with chronic kidney disease and kidney failure account for one of every five Medicare dollars as the program careens toward insolvency. Government projections show overall health care spending, left unchecked, will chew up 40 percent or more of the nation's economy by 2050.
"Transplantation ought to be mandated because the outcomes are better, the quality of life is better and it's less expensive," said Dr. Tom Parker III, a Dallas-based nephrologist who co-chaired a summit on dialysis failures in spring at Harvard Medical School.
Systemic inertia
The Trib's four-month investigation found:
