Trump Administration Looking to Cut Dialysis Costs with Home Focus

Hoping to curtail health care spending, the Trump administration is exploring ways to shift treatment for kidney disease into the home and away from dialysis clinics, a far costlier setting.

Overall, the U.S. government spends roughly $114 million to treat chronic kidney disease and end-stage renal disease, according to a Monday report by Reuters.

To decrease spending, the Centers for Medicare & Medicaid Services (CMS) is considering a trial payment model that would favor home-based kidney treatment over clinic-based treatment. The model would also improve care in the early stages of kidney disease while increasing access to kidney transplants, CMS Administrator Seema Verma told Reuters.

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“A lot of the way the program has been set up, it creates a lot of perverse incentives to actually keep people in an institutional setting,” she said.

The increasing prevalence of diabetes — which affects kidney functioning — will be among the factors causing demand for dialysis treatment to rise in coming years. Globally, the dialysis market is conservatively projected to surpass $104 billion by 2024, according to market research and consulting service Global Market Insights.

Over the past five years, the U.S. dialysis centers industry has grown by 4.8% to total revenues of about $24 billion in 2018, statistics from fellow research firm IBISWorld suggest. During that time, the number of dialysis businesses has grown by about 8%.

DaVita Inc. (NYSE: DVA) and Fresenius Medical Care AG (NYSE: FMS) are among the largest players in the market. In 2018, DaVita alone generated total revenues of about $11.4 billion, a 4.86% increase compared to 2017.

Fresenius Medical Care, meanwhile, completed its acquisition of NxStage Medical Inc. on Feb. 26, following approval by antitrust authorities. NxStage develops, produces and markets a wide-ranging portfolio of medical devices for use in home dialysis and critical care.

National Association for Home Care & Hospice (NAHC) President Bill Dombi told Home Health Care News in an email that his association — which represents more than 33,000 home care and hospice organization — is looking forward to hearing more from CMS regarding its home-focused kidney treatment plans.

“More and more patient conditions can be effectively and economically treated at home,” Dombi said. “Anything that can be done to improve access to home dialysis is a plus for patients who should not need to manage the difficult and taxing effort of leaving home for treatments.”

DaVita and Fresenius Medical Care offer home dialysis in the form of hemodialysis and peritoneal dialysis, according to Reuters. Peritoneal dialysis is a more mobile type of kidney treatment that can be done at home, at work or while traveling.

CMS is specifically considering the benefits of peritoneal dialysis.

U.S. Health and Human Services Secretary Alex Azar spoke to kidney patients on Monday afternoon in Washington, D.C., likewise calling for more dialysis treatments in the home setting.

“Today, 88% of Americans with [end-stage renal disease] start treatment with center-based dialysis,” he said. “Just 12% start treatment at home with hemodialysis or peritoneal dialysis. This is the complete opposite of the situation in some of our peer nations, including Hong Kong, where more than 80% of patients benefit from some form of in-home dialysis.”

In a statement shared with HHCN, a spokesperson from Fresenius Medical Care said the company believes it is uniquely positioned to foster innovation and to reduce costs for the health care system.

“Fresenius Medical Care shares Secretary Azar’s commitment to improving kidney health and transforming the way that care for people living with kidney disease is delivered in the United States,” the statement reads.

Roughly 30 million people — or 15% of U.S. adults — were estimated to have chronic kidney disease in 2017, according to the National Center for Chronic Disease Prevention and Health Promotion. Adults with diabetes and high blood pressure — relatively common medical conditions among the aging population and the people home health companies serve —  have a higher risk of developing chronic kidney disease compared to those without.

Other risk factors for chronic kidney disease include heart disease and obesity.

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