WASHINGTON—The Trump administration is considering ways it can adjust payments to boost access to in-home dialysis and kidney transplants.
Department of Health and Human Services Secretary Alex Azar said Monday in a speech at the National Kidney Foundation’s Kidney Patient Advocate Summit that kidney care is a service line that’s ready for a value-based payment shake-up.
Kidney care has “some of the worst incentives in healthcare,” he said.
“Today, Medicare covers most patients with kidney failure, but we don’t begin spending a great deal on these patients until they’re already sick,” Azar said. “It is the epitome of a system that pays for sickness rather than health and this administration is intent on shifting these priorities.”
Azar said HHS is focusing in three areas to reform kidney care including investing more in prevention and detection, expanding treatment options, including the latest technology and making more organs—including artificial ones—available for transplantation.
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Kidney care accounts for a significant portion of Medicare spending, Azar said. Medicare spent $79 billion in 2016 on people with kidney disease and $34 billion on people with end-stage renal disease, for a total of $113 billion—the equivalent of more than one in five dollars spent in the program.
Outcomes still lag, too, he said, despite all of that spending. One hundred thousand Americans begin dialysis treatment annually, and a quarter are likely to die within the same year. In addition, there are more than 100,000 people on the transplant list awaiting a kidney transplant.
To boost prevention and early detection, Azar said HHS intends to invest more in research to expand personalized care options within kidney care and find new avenues to identify kidney disease sooner.
For example, the National Institutes of Health will begin enrollment in a study on the APOL 1 gene, variants of which are common in black patients and are linked to kidney disease. Patients with this gene may be less likely to have a successful transplant, Azar said.
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A cornerstone of expanding access to alternatives to clinical dialysis is growing the reach of in-home care options, Azar said. In the U.S., about 88% of dialysis patients begin treatments in a center, even though in-home hemodialysis or peritoneal dialysis may be more comfortable and less expensive.
The health system incentivizes the use of clinic dialysis centers because it’s easier for those providers to care for multiple patients simultaneously in one facility compared to traveling to different homes to treat them, Azar said. In addition, federal payers may be underpaying for alternatives, making them less attractive.
“That isn’t providing the care patients deserve, and we have the power within HHS to test out significant payment changes to boost home dialysis,” Azar said.
Finally, HHS researchers are doing more to prevent viable organs from going to waste, he said. The agency intends to submit evidence on improved testing for hepatitis A, B and C, and HIV, which could grow the pool of organs available for transplantation.
HHS is also exploring payment mechanisms that can make it easier for people to be living kidney donors. The Health Resources and Services Administration is offering funding opportunities to cover travel costs and repay donors’ lost wages.
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Finally, the agency is growing access to new technology through its KidneyX innovation accelerator. Azar said KidneyX closed its first round of submissions last week, and it has received 165 proposals on ways to rethink dialysis care.
Several of these proposals include research on developing artificial kidneys, which could provide another avenue for transplantation.
“We’re thrilled with this level of interest, and it shows what a prize competition can drive in an otherwise neglected investment space,” Azar said.