Kidney Disease Patient Education Services

Kidney Disease Patient Education (KDE) Services

In Managing Your Medicare we mentioned earlier that Medicare has a special relationship with those with severe kidney disease as it covers over 90 percent of people with end stage renal disease. I want to make sure that everyone knows that Medicare has further extended this relationship, as it provides for an entirely new service called “Kidney Disease Patient Education Services.” The basic aim of this service is to intervene with those beneficiaries who have severe but not yet end stage kidney disease with the hope of either preventing or delaying the onset of end stage renal disease (which will require dialysis or a transplant) and of preparing beneficiaries for that eventuality. The benefit specifically takes into account that many beneficiaries with chronic kidney disease or CKD are elderly and have other chronic diseases, especially hypertension, diabetes and cardiovascular disease.

It is available to those with stage 4 chronic kidney disease (stage 5 is end stage renal disease), which is technically defined as a specific glomerular filtration rate (or GFR, a measure of how quickly blood is filtered through the kidney). The beneficiary’s physician that is managing the kidney disease must make a referral for this service.

Generally, this service is available only from a physician, nurse practitioner, clinical nurse specialist or a physician assistant, except in rural areas, where a variety of institutional providers, including hospitals, may also give it. However, note that renal dialysis facilities may not provide this service.

The service is limited to face-to-face sessions, of one hour duration, and these may be either individual or group sessions, or a combination. No more than six sessions are covered.

The sessions, which must be tailored to meet the needs of the beneficiary, must cover these general areas:

managing comorbidities and delaying the need for dialysis;
prevention of uremic consequences;
options for renal replacement (the various types and locales of dialysis, as well as transplants); and,
ensuring beneficiary participation in their choice of therapy.

A wide variety of specific topics should be covered, including conveying information about these items:

overview of kidney functions and disease,
prolonging kidney function,
survival rates, quality of life,
comorbidity treatment and management,
psychosocial arrangements,
renal replacement treatments and options, including transplantation,
vocational rehabilitation,
diet and exercise,
sexuality and fertility issues,
financial support and insurance, and
medication management.

The sessions should be patient-centered, encourage collaboration, and offer support to the patient.

In addition, it is expected that the beneficiary be assessed during one of the sessions for their understanding of CKD and its treatment, and their understanding of and the ability to make informed decisions about their healthcare and treatment options.

This is a Part B service; after you meet the Part B deductible, Medicare pays 80% of the cost, and the beneficiary is responsible for 20%. (For those few of you who get this in a hospital setting, you will have a copayment.)