A Poorly Designed Government Progam: Medicare (non)Coverage to Create an AV Fistula for Hemodialysis Access: A Case Study

While the U.S. government should be commended for offering universal health coverage for people with ESRD who require dialysis due to kidney failure, the Medicare program could be designed in a more efficient manner to promote increased life expectancy while saving the government money as well (in other words, have cake and eat it too.)

I want to deal with just one point to bring out this point. People who undergo hemodialysis who have vascular access points with AV Fisutulas have lower mortality rate compared to people with catheters. They also have decreased costs related to their treatment. (For examples of articles that support these suppositions, see here and here.

Moreover, Medicare's ESRD coverage does not cover the surgical procedure to create an AV Fistula before dialysis begins even though this correlates with lowered mortality decreased costs. See here for Medicares description of benefits for people with ESRD. The pertinent passage is excerpted here: "Important: Medicare won’t cover surgery or other services needed to prepare for dialysis (such as surgery for a blood access [fistula]) before Medicare coverage begins. However, if you complete home dialysis training, your Medicare coverage will start the month you begin regular dialysis, and these services could be covered." (See pp. 11-12 of the link provided above for a fuller explanation.)

Here is the bottom line. Medicare for people with ESRD should cover the costs associated with creating AV Fistulas for all people who require dialysis because this correlates with super clinical outcomes for the people undergoing dialysis (which leads to a lower mortality rate) while also resulting in substantially lower costs compared to people with catheter access.