Esrd

In the day-to-day battle of COVID-19, telehealth has emerged as an unlikely hero. However, the details of telehealth implementation and impact on staff and patients alike are still to be determined and are particularly important with respect to the care of nephrology patients.

In 1972, Congress passed legislation to fund the ESRD Program. The result was a shift in how and where dialysis was performed. With a guaranteed payment backed by the federal government, nephrologists joined with investors in opening freestanding clinics across the United States and created the three-times-a-week in-center dialysis model. According to Medicare.gov, there were 6,871 dialysis facilities in the United States at the end of 2016, the most current data available.

Under the mandatory ESRD Treatment Choices proposal, HHS and CMS propose incentives and penalties to dialysis facilities to encourage greater use of home dialysis and transplantation. CMS intends to assign half of the dialysis facilities in the United States to one of two groups based on hospital referral regions. One group which serves as the control would continue to do business as usual, and the facilities in the study group would be subject to incentives and penalties to attain certain benchmarks on the number of patients moving to home dialysis or receiving kidney transplants. The facilities in the study group that fail to achieve the benchmark would sustain penalties as high as 13% for all of their in-center dialysis treatments.

HHS is holding its first webinar, open to the public today, that will provide details on its four new voluntary kidney payment models for the recently announced Advancing American Kidney Health initiative.

One of the costliest and physically devastating health epidemics facing our nation today, chronic kidney disease affects more than 30 million Americans, largely due to skyrocketing comorbidities like diabetes, obesity and hypertension. More than 726,000 Americans live with ESRD, a diagnosis that grows by more than 124,000 patients every year.

At least 20% of people between the ages of 65 and 74 years, and half of those older than 75 years, have chronic kidney disease.1 Yet, development pipelines for the 10 largest pharmaceutical companies contain fewer than 30 active nephrology clinical investigations compared with more than 1,300 in oncology.2 In contrast with the vast number of research protocols, cancer patients are encouraged to consider inclusion in clinical studies. That is not a standard opportunity for people with kidney disease despite their eagerness to participate.3

Last summer, President Donald J. Trump launched Advancing American Kidney Health. In support of bold goals intended to reduce the incidence of ESRD, while dramatically increasing both renal transplants and the use of home dialysis, the initiative established five new payment models impacting nephrologists and dialysis providers (see Table 1).