Trump executive order to encourage home dialysis and more kidney donations: Shots

The Trump administration has announced an ambitious plan to change the treatment of kidney failure in this country.

President Trump on Wednesday signed an executive order asking the Department of Health and Human Services to develop policies aimed at three goals: reducing the number of patients with kidney failure, reducing the number of Americans who are undergoing dialysis treatment at dialysis centers and making more kidneys available for transplant.

"Thanks to today's action, we are making crucial progress under another national priority: the fight against kidney disease," said President Trump during a meeting today. of a speech delivered before the signing of the order.

Kidney disease is the 9th leading cause of death in the United States and a major expense for the federal government. Medicare supports the treatment of end-stage renal failure, including dialysis and kidney transplantation.

"Taxpayers are spending more on kidney disease – more than $ 110 billion – compared to National Institutes of Health, Department of Homeland Security and NASA combined," Joe Grogan, Chair of the Board, told reporters. of internal politics of the White House.

The decree calls for changes in three areas: prevention, dialysis care and kidney donation. To implement parts of the order, the Centers for Medicare and Medicaid Services announced Wednesday five new payment models proposed, designed to strengthen innovation in the delivery of kidney care.

One of the new models on offer includes efforts to encourage home or peritoneal dialysis.

Currently, most dialysis is administered in dialysis centers, a multi-billion dollar industry dominated by two for-profit companies. Dialysis in the center can be long and tedious for patients.

"Currently, only 12% of US dialysis patients receive it at home, which would represent 56% in Guatemala and 85% in Hong Kong," said Azar. "We want 80% of patients undergoing treatment to be in-home dialysis or graft-to-term – a radical change from our current situation."

Seema Verma, CMS Administrator, explained that the current system favors payments for dialysis at the center, but that her agency wants to start encouraging dialysis and home grafts.

"The way we currently pay for chronic kidney disease and kidney failure is not working well for patients," Verma said in a statement.

The decree proposes to change the way Medicare providers are paid to encourage them to focus on preventing the progression of kidney disease. He is also calling for an awareness campaign to help Americans suffering from early-stage kidney failure seek treatment, health and social services secretary Alex Azar told reporters. "40% of Americans with kidney disease at a given stage do not know that they have it," he said.

The organ transplant system is another goal of the executive order. Currently, nearly 100,000 people are on a waiting list for kidneys.

"Many, many people are dying in the meantime," said President Trump, addressing a room filled with kidney doctors, advocates, and patients in Washington, DC, just before signing the decree. . "We will do everything in our power to increase the supply … of available kidneys and to rid Americans of these waiting lists."

Secretary Azar said that he thought it was possible to double the number of kidneys available for a transplant by 2030. "There is currently a lack of accountability and great variability among the organizations supply of organs, "he said. "The executive branch will require a much higher level of accountability." He also said that living donors could receive compensation from the government for lost wages and child care expenses.

Finally, the decree encourages the research and development of an artificial kidney, an innovation that could one day replace the need for transplantation.

Administration officials presented Wednesday's news as the first major action related to kidney disease for decades. Previous administrations, including that of President Obama, have suggested similar initiatives, but little has changed.

Andy Slavitt, who ran the Centers for Medicaid and Medicare Services under President Obama, welcomed the announcement made today. on Twitter. "In the United States, care for patients with kidney disorders has been interrupted for a long time, due to a corporate duopoly [and] a losing low income minority population, "he wrote.

But he also pointed out that, at the announcement, the Trump administration is arguing before the courts that the Affordable Care Act should be invalidated as unconstitutional. "There is a law that makes this new change possible." The same law that forces people with [pre-existing] the conditions are covered. The ACA, "he wrote. Without that, there is no authority to do it. "

The speed with which these changes might materialize was not clear. Trump's decrees often require agencies to develop federal rules, a lengthy bureaucratic process. Another immediate change is in the way Medicare claimants are reimbursed; CMS has announced that its proposed payment models will be rolled out as of January 2020.