Congress has a moral responsibility to stop clinical labor cuts

November 18, 2022

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More and more chronically ill Americans will be cut off from the local health care clinics they rely on for life-sustaining services unless Congress acts to stop dangerous cuts to office-based specialists under the 2023 Medicare Physician Fee Schedule. This latest round of cuts will only serve to contribute to office closures, speed up health system consolidation and exacerbate health inequities.  


The Centers for Medicare & Medicaid Services has finalized a cut to key dialysis vascular access services by up to 9% under the Physician Fee Schedule. This comes after years of repeated, unsustainable reductions, including clinical labor cuts of over 20% in 2022, which are being phased in through 2025. 


As an interventional nephrologist, I know firsthand the life-altering effect this will have on dialysis patients. It will reduce patients’ options for care because vascular access centers will be forced to close due to insufficient reimbursement levels, and patients will have no other choice but to seek care in a hospital setting. Cutting a patient off from the convenience, safety and familiarity of their local provider places a huge burden on them and impacts their quality of life and care. 


People of color, those who live in rural communities and the elderly will bear the brunt of this policy, making our health care system even more inequitable. These populations often already have limited access to care and suffer disproportionately from the diseases treated by the providers who will be hit the worse by the cuts. 


Make no mistake, these cuts will undermine patients’ health, in part because hospitals have a greater potential to expose vulnerable patients to infectious diseases. Peer reviewed data has shown that patients who receive vascular access care in an office-setting have better outcomes than those patients treated in the hospital outpatient setting. Patients receiving treatment in a hospital are more likely to receive a catheter to access their bloodstream and connect a dialysis machine, rather than a fistula, although catheters have higher rates of infection, clotting and hospitalization. Limiting access to fistulas, the gold-standard of vascular access care, will further deepen health inequities. 


To add insult to injury, these cuts won’t ultimately be a successful cost-saving measure. A shift to hospital-based care will actually increase Medicare program costs and beneficiary copays.


We’ve already seen this horror movie and we know how it ends. A 2018 survey by the American Society of Diagnostic and Interventional Nephrology found that reimbursement levels were so low after cuts in 2017 that more than 20% of physicians responding to the survey reported the cuts caused their centers to close. Unless Congress acts now to reverse this latest round of cuts, they will be the final nail in the coffin for many local doctor’s offices.


The repeated clinical labor cuts office-based specialists have had to endure undermine our moral responsibility to make sure that patients with end-stage renal disease receive the best quality of care no matter who they are or where they live. The standard of care a patient receives should not depend on their zip code. 


I am calling on members of Congress to stop these cuts and focus on fundamental reform to the Physician Fee Schedule. Our representatives in Washington owe it to the American people to preserve their access to safe, affordable, life-saving care.


About the author: 


Dean C. Preddie, MD, is an interventional nephrologist specializing in dialysis access management. He is the medical director of American Access Care Physician, PLLC Manhattan in Manhattan, New York, and serves as the policy chair for the Dialysis Vascular Access Coalition.