For registered nurse Melissa R. "Missy" Cook, legislation under consideration in the U.S. Congress that would help kidney dialysis patients receive additional Medicare coverage is "very personal."
Cook is a group facility administrator for DaVita Healthcare Partners Inc., one of the largest kidney care companies in the United States. DaVita opened its East Georgia Kidney Care Dialysis Center in Statesboro in October 2014.
"This is very personal for me," said Cook, who explained her father died in 2013 after one year on dialysis.
"Yes, we consume money. We are a for-profit," she said. "But if you ask me if (the cost) is worth it, yes. It kept my dad alive for a year, and I wouldn't give that back for anything."
As one of the lawmakers who will consider the legislation, Congressman Rick Allen visited the DaVita dialysis center in Statesboro last week to learn more about kidney disease. Allen heard from medical staff about a proposal to make Medicare Advantage coverage available to patients who require dialysis. The legislation also would require federal review of the scope and funding of research into chronic kidney disease.
DaVita and its local staff members want Allen to consider supporting House Resolution 1130, titled the Chronic Kidney Disease Improvement in Research and Treatment Act.
"Obviously these are constituents, they've brought it to our attention, and that's why we're the people's House," Allen said during the visit Friday. "So we're here. We're going to take a strong look at this legislation."
Allen, the Republican representing Georgia's 12th District, toured the center and met patients undergoing dialysis. About 100 patients have hemodialysis done three times a week at the center, and about 20 others have their health monitored by the center's medical staff while receiving at-home dialysis.
House Resolution 1130, introduced in February by Rep. Tom Marino, R-Pennsylvania, with Rep. John Lewis, D-Georgia, as its first co-sponsor, remains in the House Energy and Commerce Committee, assigned to the Health Subcommittee.
Cook is group administrator over four DaVita centers, including two in Savannah, one in Brunswick and the one in Statesboro. The part of the bill she is most interested in, she said, is the extension of Medicare Advantage plans to kidney dialysis patients.
Since 1973, when a law enacted the previous year took effect, patients receiving dialysis for end-stage renal failure, regardless of age, have been eligible for Medicare. This is one of the few exceptions in which Medicare, funded under the Social Security Act, is available to people under age 65.
But the end-stage renal disease, or ESRD, program patients are not eligible for Medicare Advantage, a set of optional plans, through private insurers, that substitute for traditional Medicare. Cook says Medicare Advantage Special Needs Plans would cover some services, such as eye care, dental care and home health care, which are not covered by traditional Medicare.
"These patients, really, they don't just have problems with their kidneys, because once you start having problems with your kidneys failing, then you pretty much have a total system problem at that point," Cook said. "You're at risk for several other problems."
The complications aren't just medical. Many dialysis patients lose their teeth and lack the money to get dentures, she noted.
The bill would also mandate incentive payments, for nephrologists and dialysis centers that develop coordinated care organizations. These would provide non-dialysis services with a goal of reducing patients' overall healthcare costs.
The research element of the bill would require the Government Accountability Office to assess the adequacy of funding for chronic kidney disease research, identifying gaps. Federal agencies would have to develop a strategic plan for the research, and the Department of Health and Human Services would be mandated to study the causes and treatment of kidney disease in minority populations.
Cook, as well as the administrator of the Statesboro facility, registered nurse Sarah Garman, and the center's medical director, nephrologist Dr. Courage Atekha, told Allen that DaVita would actually like to see a reduction in the number of patients who require dialysis.
One route would be through more kidney transplants. The average cost of a transplant is $143,000, according to a statistic Atekha cited. Transplant patients also have other costs for medications, but a transplant is still less expensive than long-term dialysis, he said.
Dialysis typically costs $60,000 to $70,000 a year, Atekha said. The average lifetime cost of dialysis, according to a 2014 U.S. Renal Data System report cited in slides DaVita staff members showed Allen, is $574,000. Locally, about 90 percent of patients use Medicare, Garman said.
The dialysis process, which removes waste from the blood as a substitute for kidney function, also takes up many hours of the patients' lives. For the in-center process, most are connected to the medical equipment for four hours, sometimes longer, three days each week.
"Any day you don't have to come for dialysis is a good day," Atekha said. "So if you could get out of this place, good."
In recent decades, research into advanced kidney disease has made less progress than research in other medical fields, he said in an interview.
"Definitely, we do need more, and if there is any other alternative," Atekha said. "We have not been able to do so much in the field of nephrology in the past 40 years. There is nothing new that has really come out; although right now, they're working on something they call a wearable artificial kidney, or WAK."
The Food and Drug Administration recently gave fast-track approval for research on this device.
Atekha, who is originally from Nigeria, also said that the United States, through the Medicare funding for dialysis, has done more for kidney failure patients than many countries in the world.
"Now the average person, they get their treatment and they are able to have the opportunity to see their loved ones go to college, daughters get married, their grandkids," he said. "It's something we have in America that is not very common in my part of the world. Like in my country, God forbid, your kidneys fail, you are a dead man."
At this point, Allen has not promised to support House Resolution 1130.
"You know, we only have so many dollars, so we've got to put those dollars where we think we can do the best good with, and certainly health care is demanding more and more and more of our dollars every day," Allen said in an interview, "and that's why we passed the Cures Act."
The 21st Century Cures Act, of which he was one of 230 co-sponsors, passed the House on a 344-77 roll-call vote July 10 and has been introduced in the Senate. It contains provisions to speed regulatory approval of new drugs and medical devices by the FDA and also mandates increased funding for the National Institutes of Health.
Al Hackle may be reached at (912) 489-9458.