Trump pitches overhaul for kidney care
THE TRUMP ADMINISTRATION last week pushed forward with sweeping changes to kidney disease treatment.
HHS is tasked with developing policies to reduce the number of patients developing kidney failure, create greater access to dialysis at home, and make more kidneys available for transplant.
“This is dramatic, overdue reform,” President Donald Trump said in remarks made before signing an executive order on the policies.
Shortly after the White House event, the CMS proposed five new payment models, four of which will be voluntary. They will encourage home dialysis and kidney transplants in the hopes that increased use will reduce Medicare costs and improve patients’ quality of life.
More than 30 million Americans have some stage of kidney disease. It was the ninth-leading cause of death in the U.S. in 2016 and Medicare spent $113 billion covering those patients, including for end-stage renal disease, representing more than one-fifth of its spending.
HHS is already experimenting with ways to improve kidney care and reimbursement. The CMS’ Center for Medicare & Medicaid Innovation launched the Comprehensive ESRD Care Model in 2015, built on accountable care organization experience, to test a new payment and service delivery model to coordinate kidney care. The model, which has 37 participants, runs until Dec. 31, 2020. HHS also announced a change in its allocation policy for liver transplants, but the move was delayed due to litigation.
Congress also has considered kidney treatment reform, with less success. A bill to create a demonstration project to encourage more home dialysis, the Dialysis Patients Demonstration Act, stalled in the last Congress. A different bill, the bipartisan Living Donor Protection Act to provide employment protections to living donors and update education material on the benefits of live organ donation, was introduced in February and is in committee.
The focus on increased transplantation efforts is welcome news for many involved in organ donations. In 2018, 3,756 kidneys were recovered but subsequently discarded, according to the Association of Organ Procurement Organizations. That accounted for about 20% of the donor kidneys available for transplant. The discard rate in the European Union is only 10%. ●