Jul 10, 2019

The growing toll of kidney disease

Data: United States Renal Data System; Chart/Axios Visuals

Almost a quarter of traditional Medicare spending, or $114 billion, goes toward patients who have kidney disease. A large chunk of that, $35 billion, is spent on patients whose kidneys have failed and require dialysis or a transplant, according to the latest federal data.

Why it matters: Kidney disease diagnoses are growing, especially among older adults. Because treating it requires a lot of discomfort and money, the Trump administration is pushing for policies that will encourage more people to get dialysis treatment at home instead of in clinics, Politico reports.

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Trump wants to stem the tide of kidney disease

Note: Current through June 30, 2019; Data: United Network for Organ Sharing; Chart: Chris Canipe/Axios

President Trump signed an executive order yesterday modernizing kidney disease care for the first time in decades, a move that could reduce spending and improve treatment for one of the country's most pervasive illnesses.

Why it matters: This could be a big deal for the 37 million Americans suffering from chronic kidney disease, including 726,000 with kidney failure.

Go deeperArrowJul 11, 2019

When the Body's Filter Fails to Function

Sandeep Patel, Open Innovation Manager at the U.S. Dept. of Health and Human Services. Photo: Chuck Kennedy for Axios

The big picture: Axios Health Care Business Reporter Bob Herman hosted a roundtable conversation on Tuesday to discuss innovations in chronic kidney disease treatment and care. Sitting down with experts across academia and the public and private sectors, the conversation highlighted the substantial burden placed on patients with chronic kidney disease, the importance of making continuing education for primary care providers accessible, and brainstorming ways of having earlier interventions.

Why it matters: 37 million Americans struggle with kidney disease, and often diagnosis comes after the kidneys are already severely impacted.

Education and early intervention

The conversation began with a discussion about the challenging classification of kidney disease, specifically how such narrow terminology misses identifying the interconnected nature of kidney disease in relation to other organs.

Tonya Saffer, Vice President of Health Policy at the National Kidney Foundation, discussed the difficulty of managing a population with kidney disease when many are living with undiagnosed conditions.

Michael Spigler, Vice President of Patient Services and Kidney Disease Education at the American Kidney Fund reiterated this point.

  • "Discovering too late can be fatal...People need time to understand what the options are and whether home dialysis is worth the lifestyle adjustments it requires"

Melissa West, the Project Director of the Kidney Health Initiative at the American Society of Nephrology stressed the importance of community and patient education.

  • "The more that we can communicate action and things happening, we can create more of a community...Hopefully we can empower patients."
Working with primary care providers

Sandeep Patel, Open Innovation Manager at the U.S. Dept. of Health & Human Services discussed possible innovations in the first step of the diagnosis process — the visit to a primary care provider.

  • On the shift to home visits: "We expect primary care reimbursement to shift with half the country...When you look at primary care today, a significant amount of those visits could be home visits so why are they done in person?"
  • Restructuring payment: "Physicians get reimbursed by the number of in person visits...We need to change the reimbursement system to account for teledoc."
  • How to best serve rural communities: "The time is needed to transform and the resources are greater for rural areas...[We] need to hone in on what are the good things we are doing in these communities and what type of reimbursement programs are we are using."
Bringing innovative therapies to the market

Senior Advisor to the U. S. Department of Health and Human Services Secretary and Deputy Administrator of the Center for Medicaid Services, Adam Boehler, highlighted the forward-looking vision of the department.

  • On working together with treatment centers: "We are seeing reasonable deduction in hospitalization and a reorganization focused on the involvement of dialysis centers and working together."
  • On the role of technology: "Through apps and innovation, we’re changing how we organize and advance...HHS has launched an AI challenge for the identification treatment of kidney disease."

Thank you AstraZeneca for sponsoring this event.

Keep ReadingArrowJul 10, 2019

Whistleblower alleges DaVita, Fresenius paid kickbacks

Fresenius is one of the largest U.S. dialysis providers. Photo: Arne Dedert/picture alliance via Getty Images

A whistleblower lawsuit alleges dialysis giants DaVita and Fresenius padded their profits by donating money to the American Kidney Fund charity, which in turn subsidized patients' premiums as a way to steer them toward insurance plans that pay the dialysis firms particularly well, Bloomberg reports.

The big picture: The Department of Justice did not intervene in the lawsuit, and the companies did not immediately respond for comment. But the lawsuit reignites the debate of whether this technically legal practice is a violation of anti-kickback law, and when the federal government will propose another rule to clear the air.