The administration of United States President Donald Trump on Wednesday set goals to move more kidney-disease treatments into patients’ homes and increase transplants while reducing US reliance on more costly dialysis clinics.
Trump signed an executive order underscoring these goals, and the US health agency said it would test new payment structures, including one that rewards end-stage renal disease facilities and doctors who meet targets in these areas.
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The US government spends $114bn each year to treat chronic kidney disease and end-stage renal disease.
Nearly 15 percent of the US adult population was suffering from chronic kidney disease in 2018 – a problem fueled by growing rates of diabetes and hypertension, according to the government’s US Renal Data System.
Speaking to patients, advocacy groups and health officials an event at the Ronald Reagan Building and International Trade Center in Washington, DC, Trump said the government effort would increase the number of available organs for transplant.
“Many, many people are dying while they wait,” he said.
Trump’s wife, Melania, was hospitalized for several days in May of 2018 after an embolization procedure to treat a benign kidney condition.
US Department of Health and Human Services Secretary Alex Azar said the government aims to reduce the number of Americans developing end-stage renal disease by 25 percent by 2030, to have 80 percent of new patients either receive dialysis at home or undergo kidney transplants by 2025, and to double the number of kidneys available for transplant by 2030.
The government wants healthcare providers to focus on prevention and earlier treatment.
“The way the system is set up, it’s kind of pushing people towards dialysis,” Seema Verma, head of the Centers for Medicare and Medicaid Services, said in a phone interview.
New payment methods
Health officials said about 12 percent of Americans receive dialysis at home, in part because of a fee structure that pays doctors more when they use pricier dialysis centers. Reuters has previously reported on the government’s intention to change its payment methods.
US health officials declined to provide details on anticipated cost savings from the new treatment goals.
The government proposed testing several new payment methods, including one that will apply to about half of Medicare patients with end-stage renal disease.
In that scheme, some facilities and clinicians chosen at random would receive higher or lower payments based on the rate at which they increase the use of home dialysis and transplants.
If finalized, that programme would go into effect on January 1, 2020, and run through June 20, 2026. Other voluntary payment trials would add financial incentives for healthcare providers who are managing patients with late-stage chronic kidney disease.
The US kidney-care market is dominated by two players: DaVita Inc and Fresenius Medical Care AG, which operate more than 5,000 US dialysis clinics and control around 70 percent of the market.
DaVita shares rose 4.2 percent to $54.80, but were still trading five percent lower than before news of the pending kidney-care announcement broke on Monday. Fresenius Medical closed up 1.65 percent at 67.74 euros in Frankfurt trading.
Leerink analyst Ana Gupte said the sell-off had likely been overdone and that some details of the new rule were still to come. “It is unclear at this point what the incentives are for a shift to home dialysis,” Gupte said via email.
Healthcare has been a key issue for Trump, who tried and failed to replace the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, but who has rolled back key provisions, such as the penalty for not having health insurance. The ACA is being challenged in court.
The Republican president has also pushed drug companies to lower their prices. On Monday, a federal court struck down a new rule that would have forced pharmaceutical companies to include the list prices of their drugs in television advertising.