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By the way, one of the key aspects of their initiative would be an innovation center created under the Affordable Care Act, which President Trump strongly opposed. The proposal would create pilot programs to test different methods of reimbursing physicians to encourage early treatment of kidney failure and potentially avoid the use of dialysis.
"This is the necessary paradigm shift for the United States," said Brigitte Schiller, chief physician at Satellite Healthcare, a non-profit chain of dialysis centers, in an interview before the announcement. The current system "makes it very easy to send a patient to the centers".
In the United States, rates of kidney transplants and home dialysis have been lower than those of other developed countries, a situation that, according to many, may be blamed on a multitude of Financial incentives that discourage better options.
Companies operating clinics, such as DaVita and Fresenius, benefit from recurring visits by patients to their centers. In addition, many nephrologists or renal function specialists have a financial interest in dialysis centers in their community, either as medical directors of clinics or as owners of a joint venture interest. with a dialysis operator.
"One of the fundamental challenges is that doctors do not make a living treating kidney disease; before publication, they make money on dialysis, "said Arvind Rajan, co-founder and general manager of Cricket Health, a San Francisco kidney care start-up.
Changing the incentives "is a necessity," said Rajan, who said private insurers who pay for kidney care have already begun trying to move more people to their homes or to consider a transplant. "The landscape has really changed quickly," he said.
Although the big chains have also started selling home dialysis services, they have invested heavily in their physical centers, said Dr. Graham Abra, a Stanford University specialist, before the president's speech. "There is a motivation if you build a center to fill it and push it," he said.
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