Administration Offers Progress Report on Kidney Care Initiative

HHS on Monday offered a progress report on its yearlong initiative, Advancing American Kidney Health, which sought to reduce the risk of kidney failure, increase access to home-based dialysis, and boost availability of kidney transplants.

The report came with a clarification from CMS that patients should get surgery for kidney transplants, despite the general guidance to avoid unnecessary surgery due to the coronavirus disease 2019 (COVID-19) pandemic. CMS sought to make clear such procedures are “essential,” although the agency cautioned, “there will be instances in which local conditions will not allow for these procedures to be done due to resource constraints,” due to COVID-19.

Focusing on patients with end-stage renal disease (ESRD) is both a quality of life and cost issue for HHS, as fee-for-service Medicare spent $114 billion on kidney care, or $1 in every $5 the program spends. In its progress report, HHS outlined awareness campaigns, steps to promote value-based care, including new payment models; increased enrollment in the National Diabetes Prevention Program, and evidence that kidney failure from diabetes may be dropping among high-risk groups, including Native Americans and Alaskan Natives.

But the effort to improve care coordination has been criticized by some advocacy groups as having a fatal flaw: dialysis patients who wish to enroll in Medicare Advantage would have to do so without knowing if their health plan includes a nearby provider, including the one they may be currently using.

COVID-19 has only increased the need for reform, according to a foreword to the report by HHS Secretary Alex Azar, because patients receiving dialysis are at higher risk for infection. At the same time, those who contract the virus are more likely to develop acute kidney injury, even if they have no history of renal problems.

“The risk of COVID-19 infection among Medicare ESRD beneficiaries is 3.5 times greater compared to all Medicare fee-for-service beneficiaries,” Azar wrote, citing a department claims analysis. “Moreover, the joint risk of COVID-19 infection and death is 5.2 times higher among Medicare ESRD beneficiaries compared to all Medicare fee-for-service beneficiaries.”

President Donald J. Trump launched the initiative last year with an executive order, and Azar laid out ambitious goals:

• Reduce the number of Americans with ESRD by 25% by 2030
• Have 80% of new ESRD patients using at-home dialysis or receiving a transplant by 2025
• Double the number of kidneys available for transplant by 2030

Monday’s report featured examples of progress toward each goal, ranging from research initiatives within the National Institutes of Health (NIH) to efforts to protect civil rights of dialysis patients and end discrimination in allocation of kidneys available for transplant. A statement from HHS highlighted some examples:

• Release of a proposed ESRD Treatment Choices Model, to boost rates for home dialysis and kidney transplant
• Release of a proposal to expand what expenses can be reimbursed to living organ donors, to cover costs such as lost wages or child care
• Support for the KidneyX initiative, a partnership with the American Society of Nephrology to develop new treatments for kidney disease, including artificial kidneys and wearable dialysis machines

Efforts also call for screening more Black and Hispanic patients who may be at risk for ESRD, and to promote the availability of donor kidneys for these groups.

CMS covered new reimbursement strategies in the ESRD Prospective Payment System proposed rule for calendar year 2021, but some companies developing technology to satisfy HHS’ goals say it does not go far enough. And a group called Kidney Care Partners released a statement finding some parts of the rule it could support, while expressing “disappointment” with the lack of adjustments to current bundled payments.