Introduction
Patients with renal failure need a life-saving supportive procedure known as dialysis, which allows filtering waste from their blood, the function that their kidneys can no longer perform. It is an expensive treatment covered by the Medicare end-stage renal disease (ESRD) program, implemented in 1973 (Anumudu & Eknoyan, 2020). The Centers currently cover about 80% of the payment for U.S. citizens with ESRD for Medicare and Medicaid Services (CMS) (Mendu & Weiner, 2020, p. 721). It means that co-payment or coverage from private insurance is 20% of the total cost of the procedure. However, some patients without healthcare coverage are not capable of paying, “resulting in “bad debt” for the provider” (Mendu & Weiner, 2020, p. 723). This essay explores the problem of financial management and the impact of “bad debt” on an organizational budget in dialysis units. Although the Medicare program provides substantial support and coverage to patients eligible for dialysis, some people cannot pay the remaining 20% of the cost, but it can be resolved through collaboration with charity funds.
The Role of the Nurse Leaders in the “Bad Debt” Situation in Dialysis Centers
Nurse leaders are essential players in the financial management of dialysis centers. They serve as translators of “key issues and opportunities from clinical practice into language that financial officers can understand to make prudent decisions that balance efficiency and financial health with quality” (Zaichkin, 2018, p. 215). Nurses can also help budgeting office, CMS, and dialysis patients to attain a consensus regarding payment for this vital but expensive procedure that needs to be done frequently and regularly. Indeed, nurse leaders responsible for budgets should understand not only financial operations but also the importance of this life-saving treatment for patients. Therefore, when a dialysis center faces the “bad debt” incident, they should assist patients in connecting with charity funds that can cover this 20% (Mendu & Weiner, 2020, p. 723). It appears that nursing leaders are a critical part of financial management problems associated with CMS payments and charity help to patients on dialysis.
Regulatory Agencies and Policies about Dialysis
CMS is the primary agency involved in the universal coverage for ESRD patients requiring hemodialysis. Notably, before the legislation regarding these patients was passed, this procedure was unavailable to the majority. Furthermore, in the 1960s, death rates from kidney failure were high, leading to public criticism of the committees that used to decide who was eligible for this expensive renal replacement therapy (Anumudu & Eknoyan, 2020). It literally meant that people could die quickly from kidney failure only because they could not afford treatment. When the amendments were made to the House Bill and Social Security in 1972, and the new regulation became effective in July 1973, dialysis started to be available to all Americans (Anumudu & Eknoyan, 2020). Medicare has a unique Prospective Payment System (PPS) that transfers money to the facilities (Counts, 2020). Furthermore, dialysis centers are paid per service, which means they are obliged to comply with all the rules and regulations to receive full reimbursement (Counts, 2020). Indeed, PPS and strict guidelines were developed not to deprive the dialysis facilities of money but to ensure high-quality treatment for people with kidney failure.
The only group of patients that cannot claim this right is unregistered foreigners. Undocumented migrants can only receive this treatment in the emergency service, and they are not eligible for CMS coverage (Mendu & Weiner, 2020). They are also not offered kidney transplantation, which is the ultimate treatment for ESRD (Mendu & Weiner, 2020). Unfortunately, the system cannot provide help to everyone in need yet.
Organizational Budgets Affected by “Bad Debts”
If not resolved, “bad debts” can affect a dialysis center’s operating budget because these expenses are unexpected, requiring rearrangements from the capital budget. Since the maintenance of hemodialysis equipment is expensive, this issue can affect the overall quality of services offered by a particular facility. This issue is certainly not caused by the CMS, which faced the real possibility of bankruptcy in 2009 because its expenses exceeded its revenue (Anumudu & Eknoyan, 2020). The “bad debt” problem is an enormous systemic complication resulting from unemployment and the lack of universal insurance. Since the operating budget of a healthcare institution is often planned, the inability of some patients to pay for their treatment can damage the hospital’s revenue, future development, and quality of care.
Possible Solutions
Although single cases will not have a significant negative impact on the dialysis facility’s budget, frequent incidents can harm its financial stability. Many patients under the age of 63 who require this procedure are probably in a state of health, making them incapable of working. Thus, they may lack private insurance plans, and Medicaid will not pay the remaining cost of the service (Mendu & Weiner, 2020). It seems that the best way to resolve this problem in the United States would be changing to universal healthcare insurance. However, the transition process may take a long time and will likely face resistance in legislative bodies.
One of the possible ways to prevent this problem for a dialysis center’s operating costs is that nursing leaders and facility managers can establish communication with charity organizations to help these individuals pay their debt. For example, American Kidney Fund is one such organization that offers financial assistance to ESRD patients without any insurance plan (Mendu & Weiner, 2020). Clinicians and management should strive to maintain high-quality dialysis services for these people. Still, the ultimate solution for this issue is reducing the number of people with kidney disease. In fact, special prevention programs should promote a healthy lifestyle and timely screening to prevent conditions that may lead to renal failure.
Conclusion
In summary, dialysis is a necessary but expensive treatment for patients with kidney failure. Hemodialysis is a costly replacement therapy included in the federal program because the treatment’s price appeared to be the only obstacle to saving these people’s lives. To ensure high-quality treatment, the governmental agencies developed strict policies and regulations for dialysis centers to receive full payment for their services. Although most of the coverage for this service is done by the unique Medicare program, a small portion should still be paid by patients. If they are enrolled in private insurance, they can be covered by this plan. However, unemployed and poor citizens are at high risk of being in a “bad debt” situation. Since this circumstance can damage a dialysis facility’s operating budget, its management and nursing leaders should try to find charity funds that will cover the remaining costs not included in the CMS payment. These attempts should be made not only to increase revenue but mainly to preserve superior standards of hemodialysis to improve patients’ quality of life.
References
Anumudu, S. J., & Eknoyan, G. (2020). A historical perspective of how public policy shaped dialysis care delivery in the United States. Seminars in Dialysis, 33(1), 5-9. Web.
Counts, C. (2020). Core curriculum for nephrology nursing (Vol. 1, 7th ed.). Lulu Press, Inc.
Mendu, M. L., & Weiner, D. E. (2020). Health policy and kidney care in the United States: Core curriculum 2020. American Journal of Kidney Diseases, 76(5), 720-730. Web.
Zaichkin, D. L. (2018). Financial principles for nurse leaders. In C.R. King, S. Gerard, & C.G. Rapp (Eds.), Essential knowledge for CNL and APRN nurse leaders (pp. 197-216). Springer Publishing Group.