The White House wants to implement a number of new proposals aimed at reducing end stage kidney disease in the United States by 25 percent by 2030. The Trump administration has unveiled a package of initiatives that is being called the biggest change in kidney care since 1973. Health and Human Services Secretary Alex Azar said, “The focus has been on paying for procedures rather than paying for good outcomes. Under the president’s leadership, we’re going to flip that around.”
A major part of the proposal is to shift the way patients receive kidney dialysis. More than 500,000 people receive kidney dialysis in the U.S., most at commercial centers that serve dozens of people each day. The government wants to move more of these patients to less expensive in-home care for their dialysis treatments. Because the U.S. health care system creates incentives for clinic-based dialysis, only a small percentage of U.S. kidney patients are using the in-home treatments.
Another part of the proposal aims to reduce discards of usable organs. About 43,000 people die every year waiting for a kidney transplant due to a shortage of available organs. It is estimated that up to 75,000 usable deceased donor organs are abandoned annually. The administration wants new ways of accounting for and reporting the number of available organs transplanted and the number discarded by each of the nonprofit organ procurement organizations operating in the nation.
The initiatives also include five new payment models to encourage doctors to treat patients earlier. Under current payment schemes, doctors are generally reimbursed at higher rates for the care of dialysis patients than for the treatment of kidney disease patients who do not yet need dialysis. Another proposal would increase payments to live donors of kidneys and livers to cover more of their expenses.