DialysisPPO's ESRD cost containment solutions manage reasonable and customary dialysis charges and renal disease costs
The reimbursement environment for renal dialysis services is unlike any other in American healthcare for two reasons. Firstly, End-Stage Renal Disease (“ESRD”) is the only Medical diagnosis that entitles a patient to Medicare — regardless of their age. Secondly, over the course of the past ten years, consolidation amongst dialysis providers has resulted in two large organizations treating approximately 72% of all U.S. dialysis patients. The confluence has created a cost environment that is exceptionally challenging for health Plans.

Because Medicare becomes the primary payer for ESRD patients after 33 months of treatment, approximately 75% of a dialysis facility’s census is comprised of Medicare patients. The provider community has stated that the Medicare payment rates are not sufficient to cover their average cost of providing a dialysis treatment. When you lose money on 75% of your volume, you have to make extraordinary profits on the remaining minority. Our clients are among this group. On average, our clients are charged 2550% of the Medicare allowable amount for the same services.

Small employer group health Plans that self-fund for benefits are particularly hard hit in this environment. Most have one or a few ESRD members, and as a result lack any bargaining leverage with these large provider organizations to manage ESRD costs. However, that one or a few cases can cripple the Plan — and even the larger operations of the employer — financially. We have encountered small employers that have had to face the difficult decision of whether to eliminate their benefits entirely or lay off a handful of employees to save costs after experiencing an ESRD case.
Approximately 72% of All ESRD Patients in the United States Are Treated by Just 2 Large Provider Organizations.
Our Average Client's Charges Are 2550% of Medicare Allowable Amounts for the Same Services.
Contact DialysisPPO for reasonable and customary cost containment dialysis and ESRD claims options and consuting services