OCEAN PARK – For four hours a day, three days each week, Kenneth Schmaltz sits strapped to a machine that cleans his blood because his kidneys can’t.

At the North Coast Dialysis Center in Astoria, the machine cycles through his blood, filtering out buildup and waste, extra salt and water before pumping it back into Schmaltz, an Ocean Park resident who until March worked in construction.

About 320,000 Americans require dialysis to live. With an estimated 2,500 Oregon kidney disease patients starting the treatments last year, it’s a growing group that mostly relies on financial support from Medicare, the federal government-funded insurance program.

But as the population has climbed, Medicare payments to dialysis providers have stagnated, prompting warnings of a looming crisis from kidney-care advocates as well as proposed changes to Medicare’s End-Stage Renal Disease program.

The Kidney Care Quality and Education Act would establish a framework for updating Medicare payments for dialysis treatments. It would also create education programs to raise awareness of chronic kidney disease, factors that lead to kidney failure and ways to delay or prevent end-stage renal disease. The bill, which in both the House and Senate remains in early stages of the legislative process, is co-sponsored by Oregon Sen. Gordon Smith and Reps. Earl Blumenauer and Peter DeFazio.

Steve Reph, clinical manager of North Coast Dialysis Center, said the changes would help providers “intercept what we know is coming at us” while supplying “money to be able to maintain what we have.”

“We’re struggling with what we’ve got,” said Reph. “We need education to help and we need the composite rate to come up; we need to know every year we can count on this money so we can utilize our resources and help the situation.”

Medicare covers the costs of end-stage kidney disease for 75 percent to 80 percent of patients, regardless of age. That amounts to $19.3 billion, an increase from $8.9 billion 10 years ago, according to the U.S. Renal Data System’s 2007 report.

However, unlike Medicare payments to other types of providers, the reimbursements for dialysis aren’t adjusted each year. Meanwhile, the costs of delivering those services have skyrocketed.

“Per treatment, we’re actually operating at a loss with the composite rate the way it is right now. The only way we’re able to move forward is by continuing to condense our efforts,” said Reph.

Rick Stotz, regional vice president for Fresenius Medical Care North America, the Astoria clinic’s parent company, said other health providers have “update mechanisms” in place that allow their payments to increase with inflating costs.

“Because we have to improve or enhance our equipment or technology, and we have to continue to pay our staff competitive wages, the fact there is no composite-rate increase makes it very difficult for us,” Stotz said. “What we’re looking for is the government to say, ‘We need to make it equitable.'”

Along with providing a structure for reimbursement rate increases, the kidney care bill would funnel more money into education initiatives, helping people identify and manage kidney disease.

The earlier kidney disease is detected, the better the chances of slowing or stopping its progression, according to Kidney Care Partners, a national alliance of dialysis patients and providers. However, its symptoms often don’t surface until damage is severe, and many people aren’t aware of its risk factors, such as obesity, diabetes and high blood pressure. According to the group, physicians can test a kidney’s function with a blood test, but they don’t always do it.

“Many times, I think they’re finding out too late,” said Reph. “It’s really upside-down. By the time you’re designated end-stage renal disease, you only have 10 percent kidney function. Something needs to be done now.”

Prevention could

prolong lives

While prevention efforts and careful management may not ultimately keep patients from needing dialysis, it could prolong their lives.

“Many of these patients don’t die from (kidney) failure,” they die from complications involving related medical conditions, said Reph. “If education went out ahead of time, it would assist us in providing dialysis. … It would promote life for them and actually make dialysis run smoother and better.”

Organ transplant is an alternative treatment when kidneys fail, although it’s less common, he said. Of almost 50 patients at the Astoria dialysis clinic, an average one or two undergo transplants each year.

Schmaltz has driven 30 miles from Ocean Park to Astoria every Tuesday, Thursday and Saturday for dialysis over the past two years. And he’ll continue to do so until – unless – he receives an organ from a donor.

He calls Oct. 29 his “one-year anniversary” on the waiting list at Oregon Health and Science University in Portland. But a transplant likely won’t end his problems.

While Medicare foots the $20,000-per-month bill for Schmaltz’s dialysis treatments and medications, it only covers three years of the post-transplant drugs he’ll need the rest of his life to keep his body from rejecting the new organ. Right now, those drugs cost $5,000 a month, according to local estimates.

Schmaltz won’t be eligible again for the federal insurance program until he’s 65 years old. He’s 57.

“I had to agree that once I ran out of Medicare insurance, to keep from losing the kidney I’d have to mortgage my home, my real estate,” he said, “so then I’d have the money to get my anti-rejection drugs.”

Apparently no one has lobbied for federal funding on that front.

“We’re kind of in the same boat, trying to have our services covered, as are the folks doing transplants and trying to have that continuation coverage,” said Stotz. “As far as I know, nothing is in the works right now to get that passed, but we need it.”