Rethinking kidney dialysis in the age of COVID

In an election year, you can’t go a day without hearing some politician somewhere cry out for reform of the nation’s healthcare system. Even former Vice President Joe Biden, whom the Democrats nominated for president last week, devoted a considerable portion of his acceptance speech to the issue.

The solutions to the problems we face won’t be found by rearranging the deck chairs on the Titanic system America has built to deliver healthcare and pay for it. What the policymakers should pursue are solutions arising from innovations that lower costs and improve patient care.

That sometimes involves looking backward. In 1973, 40 percent of all kidney dialysis was done at home. In 2020, that number is 10 percent, largely because of a 1972 law that made Medicare the entity responsible for dialysis payments regardless of need. Perversely, that incentivized innovations good for providers and payers and generally killed home care.

Both kinds of dialysis -- hemodialysis, which involves filtering the blood outside the body and then returning it under supervision, and peritoneal dialysis, where the blood vessels in the lining of the stomach filter the blood with the help of a cleansing solution -are now typically performed at hospitals and big, expensive dialysis centers.

That’s inconvenient, and it can be expensive, time-consuming, and risky. It forces people who are already sick and vulnerable to other kinds of diseases out into the world where they must mix with other sick people. As we’ve learned while trying to combat the coronavirus, that can be a deadly combination. Instead, care should come to the patient.

The smart play is to push dialysis back into the category of a procedure generally performed at home. The big machines and all the other aspects of the hospital and dialysis center treatment setting aren’t always necessary. When they’re not, being able to be at home, taking treatment while sleeping or performing other routine tasks ought to be an easy choice.

America spends more than $110 billion a year fighting and treating kidney disease. It’s the ninth leading cause of death in the United States and affects more than 37 million people. That’s not sustainable. Recognizing this, the Trump administration recently issued a plan to “shake up” kidney care. By executive order, the president directed the Department of Health and Human Services to develop policies to increase the number of patients getting dialysis at home instead of in hospitals and at dialysis centers.

The industry and the bureaucracy may not like this, but the patients and doctors should love it. It frees up caregivers, allowing them to focus on those with the most critical needs while making things easier for people already fighting a tough fight. Starting in 2021 people with end-stage renal disease will be eligible to enroll in Medicare Advantage plans to cover the costs associated with their care. That’s an essential first step toward expanding home care, but only if the government and the insurance providers negotiate for fair rates and prevent costs from rising that leaves all seniors paying for it. The Centers for Medicare and Medicaid Services can and should be leading in this area by removing any impediments that keep everyone from to getting to “Yes.

Scholars and policymakers continue to focus on flattening the healthcare cost curve by imposing price controls and rationing. That doesn’t work. It may reduce the perceived costs of care, but it doesn’t solve the problem.

We need to be looking for what works -- or once worked -- best. Like house calls and home care.

Peter Roff is a senior fellow at Frontiers of Freedom and a former U.S. News and World Report contributing editor who appears regularly as a commentator on the One America News network. Email him at RoffColumns@gmail.com. Follow him on Twitter @Peter Roff.