Compared to the baseline wave (conducted in June 2009), medical directors report a significantly higher awareness of the ESRD bundle and have become decidedly more negative about the impact to patient outcomes. Close to three-quarters of the respondents now expect bundling to have a “negative” impact on patient outcomes, compared to 43% in June. An area of particular concern for the research participants is the inclusion of oral medications (phosphate binders and cinacalcet) in the proposed rule, which was released in September.
Almost half of the respondents indicated active or planned pilot programs to evaluate the impact of various clinical strategies under the new payment system. A majority of respondents anticipate a decrease in the use of ESAs through a shift to subcutaneous dosing, potentially lower hemoglobin targets and dose limitations in select patients. In bone and mineral metabolism, more than half of the medical directors suggest that a shift to calcitriol (from Abbott’s Zemplar and Genzyme’s Hectorol) is likely and a major offset to Amgen’s Sensipar is projected. And although an increase in the use of calcium based phosphate binders was deemed to be “not in the best interest of the patient” by a majority of medical directors, future market share projections indicate increased use of these agents in place of more expensive, non-calcium agents such as Genzyme’s Renagel/Renvela and Shire’s Fosrenol.
The third wave of this research will be fielded following the release of the final rule which is expected in the next few months.
Commentary from somebody who has a loved one on dialysis:
Did you get that? What the doctors have established as the best care for ESRD? They can’t give you that under Obamacare and they have been figuring out the minimum they can do on what they will have now that will keep you alive – barely. This is important for you to understand. This is real. It is happening right now under Obamacare. Am I reaching you yet?
What this is, is people who have been forced into Medicare by machinations designed to help the poor and unless they can pay for the treatment on their own without the assistance of insurance, because private insurers won’t cover it, because the government covers it … they are now subject to rationing. Was that clear enough? I can never tell. This is your future.
I don’t expect you to give a rat’s ass about people with a disease you’ve never heard of, getting ‘free” treatments when – if poor – they would probably be dead, so beggars can’t be choosers. I expect you to understand that the way this works is the way Obamacare will work and while it’s admirable to care for the poor, the people who are average, middle class workers are sucked under and their options are stripped from them. And. At the whim of the government. They are looking at a modern zombieland with no way to save themselves from the budget cuts. Their treatments will be cut from the more expensive drugs and care that keeps them active and productive, to just barely enough to keep them breathing and there is not a damned thing they can do about it unless they are rich.
This, my friends, is YOU in five years. Never has a Medicare cut demonstrated more clearly that the government, when given the power of life and death over people, will begin by allowing you to live – and thanks a lot for that, btw – and then when money is tight or priorities are different, they drop you into the abyss. You’re ability to find your own way – all avenues you might have used to save yourself are cut away because the private sector cannot compete, and WILL not complete with the US Government.
Starting in 2011, your life will be in danger from the Federal Government if you require dialysis.