While most people scramble to wrap last-minute gifts, Don Holcombe and a dozen other dialysis patients hasten to untangle a life-threatening dilemma caused by the impending closure of the Rim country's sole kidney dialysis facility.
"We didn't find out until last Friday this was happening," Holcombe said. "This all happened at the wrong time. We're all scrambling to figure out what to do next."
When the Payson Renal Care Group goes out of business the second week of January, a handful of dialysis patients will be left with few treatment options.
Although Payson Renal Care Group declined to comment on the clinic's closure, Terry Proveaux of Renal Care Group Inc.'s headquarters in Nashville, Tenn., said the clinic has been losing money for at least a year.
"We've struggled with this from an emotional and moral standpoint," Proveaux said. "But there aren't enough patients to pay for services and personnel."
Payson's remote location compounds the frustration for dialysis patients seeking other treatment solutions.
"We're working with patients to find alternatives," Proveaux said. "The renal group can't provide transportation, only Medicare can do that."
Failing eyesight caused by diabetes and other kidney disease prevents patients from driving to the Valley for dialysis; most kidney patients are on fixed incomes, and can't afford private transportation; and home dialysis options have limitations -- one requires visits, not covered under Medicare, by a certified renal practitioner, and to qualify for the other dialysis system, patients must meet stringent health guidelines.
Patients diagnosed with End Stage Renal Disease or ESRD -- a permanent failure of the kidneys that requires full-time dialysis or kidney transplant -- are automatically eligible to receive Medicare benefits.
Since few ESRD patients carry commercial insurance, outpatient clinics, like Payson Renal Care Group, contract with the Centers for Medicare & Medicaid Services (CMS) to provide dialysis and other renal-related services for patients suffering from ESRD. Medicare then reimburses these outpatient facilities for services rendered.
Most ESRD patients, like Holcombe, visit the clinic three times a week where they sit for four hours while their blood is filtered through a dialysis machine.
The problem of keeping the Payson Renal Care Group open, Proveaux explained, is simple economics.
"Medicare reimburses $131 per treatment, per person. That is supposed to cover everything we do with the exception of administering drugs," she said. "It doesn't matter if you have insurance or not."
Because, according to Proveaux, private insurance only covers the first 30 months of treatment, Medicare then kicks in and covers the rest.
Proveaux estimated that one dialysis treatment, per patient, costs the clinic an average of $300, which means Payson Renal Group supplements about $169 per patient, per visit to cover expenses not picked up by Medicare. Therefore, if the clinic sees 10 patients three times a week, Payson Renal Care Group is left with a $5,070 tab beyond Medicare payouts.
"We're just totally bummed," Proveaux said. "But under the reimbursement we're working with, it's impossible to keep this clinic open."
The dialysis industry thought it would get a break when the Medicare Modernization Act passed in 2003, but, Proveaux said, the increase is too little, too late to keep the Payson facility open.
"We've not had a significant increase in 24 years," she said. "Not only do the reimbursements stay the same when costs go up, the reimbursements are insufficient to begin with."
Case in point is the 1.6 percent Medicare Modernization Act reimbursement increase, which becomes law after Jan. 1, 2005. The increase will add $2.10 to the current $131 reimbursement. That's hardly enough to buy a good magazine for the waiting room.
But underfunding is just one problem the clinic faces. Proveaux said hiring and retaining employees are next to impossible because once they're trained, they move on to better paying jobs.
"It's hard to get qualified staff," she said. "Every facility by Medicare rules must have a director, and that is usually a nephrologist, in this case, he's an independent contractor."
That nephrologist, Dr. Peter Leopold is on vacation, and his return from the holidays cuts close to the Payson Renal Care Group's closure, causing logistical planning problems for patients.
In the meantime, Holcombe and other patients are trying to make alternative arrangements and transportation, paid out of their own pockets, to the Valley in case they aren't eligible for or can't afford home dialysis.
"We trying to get a van together to carpool," Holcombe said. "If we can get six patients in one van, that'll be $33 a trip, and that's if we can get six patients. If not, it'll be more expensive."
Holcombe also said that relying on family members to drive back and forth from Phoenix three times a week is unfair.
"If you're on dialysis, it becomes a real family problem," he said. "A lot of dialysis patients don't drive so they have to have a spouse bring them down and wait for three or four hours."
Several months ago, Proveaux said Renal Care Group, Inc. approached Payson Regional Medical Center to take over dialysis services. PRMC refused to willingly take kidney patients, but Proveaux said PRMC agreed to treat acute, emergency cases only.
"We tried to get local community hospitals to take over services, but they won't," she said.
Calls to Payson Regional Medical Center have gone unreturned.
Holcombe said, in the end, the Payson Renal Care Group's closure shows a lack of progress in the community. "I think it's going to hurt Rim country," Holcombe said. "Nobody's going to want to move to Payson because there's no dialysis up here."