End Stage Renal Disease

Seven years after Medicare was enacted in 1965, Congress extended Medicare coverage to Americans under age 65 with end stage renal (kidney) disease (ESRD).  If you build it they will come and now over 45 years later, dialysis center for treating ESRD are nearly as plentiful as Starbucks outlets. A 2018 Congressional Research Service report explains

Medicare spends far more on medical services for beneficiaries with ESRD than for other beneficiaries. In 2013, Medicare spent $61,996 per ESRD beneficiary, compared to $9,889 per non-ESRD beneficiary.29 Medicare per-capita spending for all beneficiaries was $10,478 in 2013, the most recent data available.

These statistics are even more eye popping when you consider that employer sponsored coverage like FEHBA pays primary to Medicare for plan members with ESRD for the first 30 months of treatment. 

Today the President issued an Executive Order on controlling ESRD spending. Medpage Today discusses the EO here. HHS has already taken initial steps to implement the EO. Good luck.