Many rural Tennesseans count on local medical offices for affordable care and a new federal payment rule could help dialysis patients maintain access to those services.
The 2026 Medicare Physician Fee Schedule boosts support for office-based procedures, including increased reimbursement for dialysis centers.
Dr. Omar Davis, president and medical director of Bluff City Vascular in Memphis, said low reimbursement rates have caused many clinics to close or sell out, driving patients back to hospital settings, where they are more likely to have a catheter inserted. He noted research from the Healthy People 2030 initiative showing a 25% increase in catheter use last year.
"Our patients do better when they dialyze with a fistula or graft versus a tunneled catheter," Davis explained. "Morbidity and mortality rates are significantly higher with catheters. Unfortunately, there is a direct correlation with the decline in dedicated access centers and a rise in catheter rates."
More than 1.4 million Tennesseans are on Medicare. Davis argued outpatient labs are vital to the dialysis community for their flexibility, accessibility and dependability, especially for patients who face barriers like transportation.
Terry Litchfield, patient advocate for the Dialysis Vascular Access Coalition, said dialysis care works best when patients receive treatment in the right setting. She believes it places an unfair burden on older adults and minority groups, with far more dialysis patients relying on Medicare and Medicaid than those with other serious illnesses.
"Kidney disease unfairly burdens the elderly and minorities," Litchfield pointed out. "Black Americans specifically have three times the rate of dialysis than they are represented in the overall population."
Litchfield added mortality is four times higher for patients using catheters compared with those who have permanent access, like a fistula or graft.
Medicare spent more than $53 billion treating end-stage renal disease in 2023.
Jason McKitrick, executive director of the Office-Based Facility Association, is raising awareness about improving care and fairness for Medicare providers. He said Congress is considering bills like the Promoting Fairness for Medicare Providers Act, which aims to reduce catheter use and increase fistula procedures for office-based vascular access centers.
"It would help to stabilize these office-based centers and pay them more appropriately for their practice expense and align them better with the hospitals and ambulatory surgical centers," McKitrick outlined.
The bill was referred to the House Subcommittee on Health in 2024. No action has been taken since.
Source: Public News Service
