Indianapolis Recorder, Indianapolis, Marion County, 23 June 2000 — Page 2

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THE INDIANAPOLIS RECORDER

FRIDAY, JUNE 23,2000.

Study shows Blacks not getting equal kidney care

By DR. KEITH NORRIS Acting Chairman, Department of Internal Medicine Martin Luther King/Drew Medical Center There is a new and urgent need for Medicaid patients, in particular AfricanAmerican patients, to understand a potential threat to the quality of care they receive for certain health problems, including kidney disease. A recent study of kidney patients confirms what was suspected earlier: African Americans, for a number of reasons, may not be getting the quality of care received by much of the population. *:And it is possible that this situation could worsen if those persons are Medicaid or Medicare patients who, because of factors beyond their control, may have to join a managed care program that does not have an in-depth understanding of the renal replacement care program for dialysis and kidney transplantation. Many in the field of kidney disease have long held that African-American ESRD patients need more awareness of not only the causes of their illness, but also the specific treatment options available to > them. Whether it is because of fear of high costs or impact on lifestyles and family, there is abundant evidence African Americans are not availing themselves of the : kind of care that can give them longer and Itiwte productive lives. And now, a recent survey conducted by the Harvard Medical School and Brigham

and Women’s Hospital in Boston confirms these concerns. Today, thanks to dialysis and new medicines, ESRD patients are much more able to maintain their standard of health so that they can be considered for transplants. However, the Harvard survey shows that substantially fewer African-American kidney patients than the general population are referred for evaluation for a transplant, and even fewer are placed on a waiting list for transplants. It is my view that if patients are given the opportunity to better understand the options available, they will pursue them. That is why it is very important that ESRD patients and patients suffering from diabetes or high blood pressure, both threshold conditions that can lead to serious kidney disease, and the families of those patients establish better communications with their health care providers. Despite evidence of variable quality of care for kidney disease patients under an HMD setting, there is currently an effort by the Federal agency that manages Medicaid and Medicare, the Health Care Financing Administration (HCFA), to remove a regulation prohibiting kidney disease patients from being enrolled under managed care. Few managed care organizations have demonstrated the capability to effectively care for this unique group of patients. Why is this proposal important to members of minority communities? One reason already discussed is the disproportionately high number of Afri-

can Americans with serious kidney disease covered under Medicare. Removing the current regulation could expose those patients and those at high risk of kidney disease to a managed care plan that may not provide adequate acute and chronic care services and management needed by those patieiits. Many in the medical profession feel this action is at best premature. There is currently a study under way to assess the quality of care to kidney patients by a selected group of HMDs. A final report on this study is due in 2001. However, even before the study is completed, Congress is considering action that could remove the present prohibition. The results of this study and data from those managed care organizations that are providing quality care are important to generate standards for HMDs that will ensure quality care for patients with kidney disease. Otherwise there could be many patients entered into programs The American Association of Kidney Patients (AAKP) is also very concerned about the future of the Medicare ESRD program. AAKP is urging Congress to maintain the current ESRD rules until the appropriate safeguards and standards can be developed and enforced. Given the life-sustaining nature of dialysis treatment, any changes in the Medicare payments or policy creates concern for the 300,000 beneficiaries now in the program. These changes need to be developed with extreme care and diligent detail for patient safety.

The AAKP is most concerned about efforts to place Medicare ESRD beneficiaries in managed care plans because the ESRD patient population is one of the most vulnerable segments of the Medicare program. Cost constraints and selective access could prevent patients from obtaining needed services. Most HMDs have very little experience with the ESRD population: only 5.4 percent of the current ESRD population is enrolled in managed care. The AAKP is also worried that in an effort to cut costs in a managed care environment, hospital admittance times have been shortened for transplantation. This could lead to only the healthiest patients receiving transplants because the hospital can guarantee a short patient stay. In a managed care situation, some dialysis patients could find their travel plans curtailed by the fact that their destination facility would not be covered in their managed care contract. They would need new doctors, new nurses, new dietitians and new social workers that could significantly impact an effective communication and patient care program that may have taken months to years to develop for many patients. These relationships are all that many patients have in their life. While the cost of care is always important, HCFA’s proposed policy changes appear premature. Patients without functioning kidneys who require life-sustaining services include a high level of at-risk persons, such as racial and ethnic minorities, socio-economically disadvantaged.

and elderly Americans. ” When one adds the effects of chronife! kidney disease on a patient’s cognitivfec state, these patients are at the greatest ristf* of being misinformed and misled abotf£ available services and related support f<j£ their care. As a group these patients are i like many others now enrolled in HM( who are in need of preventive care, pei^ odic screenings and occasional acute care; services. ^ In the states of Maryland and Nef£ Y ork, coalitions of people concerned aboflf the impact of shifting kidney disease patients to managed care have blocked mai^ dated transfers of Medicaid enrollees fr HMDs. if The concerned citizens included rensrf' administrators, social workers, and local chapters of the National Kidney Founda- • tion, patient advocates and local medical practioners. If you or your family have serious kid-; ney disease, hypertension or diabetes, I; urge you to contact your Congressperson: and ask that any HCFA policy change! forcing kidney disease patients into man-! aged care be stopped until appropriate patient safeguards accepted by the renal; community can be implemented. If you need further information on this \ serious issue, write or call: National Kidney Foundation 800-622-9010, American; Association of Kidney Patients'. 800-638-8299, or American Kidney Fund 800-749-2257. .1

- ATTENTION - Saint Andrew the Apostle School is now enrolling for the Fall of 2000. Preschool for ages 3 & 4 year olds - operating hours 6:30am - 5:30pm. All day kindergarten and grades 1-8. For information call 549-6305.

| Vidor N. Egwu, M.D. Orthopaedic Surgeon ^Announces ‘Relocation to Indianapolis 3266 N. Meridian St., Suite #404 Indianapolis, Indiana 46208

Phone:}17/925-2790 Office Hours Available Monday - Friday

Dr. Egwu is a graduate of Howard University School of Medicine, Washington D.C. He completed his residency in Orthopaedic Surgery in 1986. Dr. Egwu is board certified in general orthopaedic surgery and is a Fellow of the American Academy of Orthopaedic Surgeons. Dr. Egwu has been practicing general orthopaedics for the past 13 years in Indiana and has special interest in arthritis and arthritis related surgery. Dr. Egwu lives on the northeast side of Indianapolis with his wife and son.

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“It is very important that African American patients suffering from diabetes and high blood pressure, both threshold conditions that can lead to serious kidney disease, and the families of those patients establish better communications with their health care providers.... There is abundant evidence that African Americans are not availing themselves of the kind of care that can give them longer and more productive lives.” —Dr. Keith Norm. Acting Chairman, Department of Internal Medicine Martin Luther King/Drew Medical Center If You, a Family Member or Friend Fit the Kidney Disease Profile, Call One of the Following Organizations for More Information National Kidney Foundation

800-622-9010 www.kidney.org

American Kidney Fund

800-638-8299

www.kidneyfund.org American Association of Kidney Patients

800-749-2257