Miami Hospital System Pulls Plug on Dialysis For the Poor

A hospital system that provides affordable healthcare or complimentary medical services to the poor and uninsured in Miami-Dade County has announced it will cut dialysis treatments for nearly 200 patients with progressive kidney diseases and renal failure.

Jackson Health System, a quasi-government and privately funded consortium of primary care clinics, mental health facilities hospitals in the region made the decision as a direct result of rising medical costs and funding cuts from local and federal governments. Jackson estimates it will save about $4 million per year by eliminating the dialysis program.

“This decision was not taken lightly,” Eneida Roldan, chief executive of Jackson, tells the Miami Herald. Roldan explained that Jackson is trying to reduce a projected loss of $168 million for fiscal 2010. She said patients can still get treated in the emergency room.

According to the National Kidney Foundation, some 26 million Americans are living with kidney disease. About 300,000 of them suffer from End Stage Renal Failure (ESRF), a non-reversible disorder that eliminates the body’s ability to filter waste products from the blood. Without dialysis — a mechanical process whereby a machine essentially “washes” the patient’s blood three times per week for about three hours on an outpatient basis — the patient requires a kidney transplant in order to survive.

Other medical facilities in the Miami area have offered to come to Jackson’s aid in an effort to provide care for its indigent dialysis patients. Jackson estimates about a third of them are undocumented immigrants. Although the federal government does provide guaranteed Medicaid coverage for dialysis treatment, the process for applying for benefits takes about a year and does not pay claims for illegal citizens. What’s more, the federal government requires that beneficiaries must have “paid into” the Medicare program for a certain period of time through payroll deductions before they can receive coverage.

So far, all but about 40 of Jackson’s dialysis patients have successfully located alternative sources of care for dialysis treatments. In addition, nearby Baptist Health South Florida (a private, for-profit healthcare company) has called for a charitable medical partnership to create a new, ongoing safety net for the patients who require dialysis.

“These people are going to seek treatment,” Keeley tells the Herald. “They’re going to migrate to the nearest emergency room,” after they become sick, meaning care will be more expensive. Such a scenario is “very inappropriate” when they could be kept well at outpatient dialysis centers, he said.

Under the healthcare reform proposals now before Congress, the emphasis is on getting cheaper basic care for an additional 30 million Americans to reduce emergency room care for those people without a primary care physician or health insurance.

Gerard Kaiser, Jackson’s chief medical officer, justifies the decision to end dialysis treatment at its facilities because various government programs pay for inpatient dialysis but don’t pay for outpatient treatment. He also explains that the savings Jackson will receive will come at the cost of shifting care to other facilities in the community, since they may end up at ERs other than Jackson’s.

The National Kidney Foundation counters such an argument on its Web site, where the organization is calling for higher reimbursement rates for dialysis from Medicare. The NKF also fears that healthcare reforms under consideration by Congress could unintentionally threaten patient access to dialysis facilities, since they depend on the cross-subsidization of private insurance plans to allow them to continue operating.