Trump signs executive order to revamp kidney care, organ transplantation

Washington — The Trump administration pledged Wednesday to reduce end stage kidney disease by 25% by 2030, proposing to provide better care earlier in the disease’s progression and double the number of kidney transplants performed in the United States.

President Donald Trump signed an executive order Wednesday morning that is also designed to move many of the more than 500,000 people receiving kidney dialysis away from commercial centers to less expensive in-home care.

Trump said the order delivers “ground-breaking action to millions of Americans suffering from kidney disease. It’s a big deal.”

In a briefing for reporters before Trump’s speech, Joe Grogan, head of the White House Domestic Policy Council, described the package of initiatives as the biggest improvement in kidney care since the government extended coverage of kidney failure under Medicare in 1973.

Medicare spends more than $110 billion on kidney care, about 20% of all fee-for-service dollars paid out by the giant government health insurance program.

“The focus has been on paying for procedures rather than paying for good outcomes,” Secretary of Health and Human Services Alex Azar said in the telephone briefing. “Under the president’s leadership, we’re going to flip that around.”

The initiatives Trump outlined include five new payment models to encourage doctors to treat patients earlier and encourage home peritoneal dialysis; a crackdown on some of the 58 non-profit organizations that do a poor job of collecting organs for transplant; and a public awareness campaign aimed at patients. About 40% of people with kidney disease do not know they have it, officials said.

Azar noted that in Hong Kong 85% of kidney patients who require dialysis get it at home, and in Guatemala, 56% use that method. In the United States, only 12% receive inhome dialysis, often delivered while patients sleep.

Kidney dialysis is a grueling regimen endured by about 510,000 of the 726,000 people who suffer from end-stage kidney disease, according to the National Kidney Foundation. In the United States, most people receive hemodialysis, a treatment that requires a device to filter waste and toxins from their blood. Most receive it in clinics or private facilities that serve dozens of people each day.

Average life expectancy for a person on dialysis is five to 10 years, though some live much longer.