Is it fair to work for a new federal program, if it will personally benefit you? Even if it will truly benefit thousands of others? That is something with which I am struggling right now.
The National Kidney Foundation is an advocacy group (that solicits donations) which wants to prevent urinary tract and kidney diseases (chronic kidney disease, CKD), as well as improve the health of those who are directly affected by the disease, and their families. And, now it is advocating a new system, one with bundled Medicare payments to primary care health practitioners and nephrologists aimed specifically at early detection and optimal CKD management.
The goal is to preclude more people undergoing dialysis, which is a tremendous cost to the federal treasury; dialysis costs are primarily paid through Medicare for all US citizens. (There is an 18 month waiting period.) And, this new plan was presented to Senator Mark Warner (VA) and Johnny Isakson (GA), because they are on the Senate Finance Committee, charged with finding ways to lower Medicare’s dialysis costs.
The annual total for the CKD program is $ 87 billion, with 2/3 of that going to stages 1-4 (stage 5 is End Stage Renal Disease, ESRD, which is where dialysis kicks in.) And, Medicare spends somewhere between 2 and 7 times the amount devoted to normal Medicare patients when dealing with the CKD population.
The proposed program with include a bundled payment plan that will be tied to quality measurements and improvements to early detection and better management of CKD- which can hopefully forestall ESRD incidence. The program also hopes to work in reduction of cardiovascular disease risk, since many of the CKD conditions also incur these risks. Additionally, 4 payments would be tied to better metrics, which should lower the overall costs for this portion of the program.
The idea is to pilot a new program for CKD patients who do not have ESRD (those in stage 4), facilitating new programs to offer shared savings to the nephrologist, the government, and the primary care physician. (This is the portion of the program where my business idea fits.)
So, while I really consider these ideas great ways to save our government money and still provide better care, I wonder if my thinking is tainted by how my ideas can profit from the program. And, I sit on the sidelines, pondering.
