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Analysis

Trump Administration Launches Kidney Health Initiative

By John Commins  
   July 10, 2019

Kidney disease accounts for about $114 billion, or 20%, of all traditional Medicare spending each year.

President Donald Trump on Wednesday launched an initiative that he says could save thousands of lives each year by increasing the transplantable kidney supply, expanding home-based dialysis options, and reducing kidney failure with proactive, preventive care.

"Today we are taking ground-breaking action to bring more hope to millions of Americans suffering from kidney disease. It's a big deal," Trump said Wednesday during a signing ceremony for "Advancing American Kidney Health."

"I've spoken to people (on dialysis). They say the work is so intense, The time is enourmous that they spend. it's like a full time job for people," Trump said. "These patients, their loved ones and for all those impacted by kidney disease, I am here to say we are fighting by your side and we are determined to get you the best treatment anywhere in the world."

Trump said that providing incentives for organ donors and streamlining the kidney procurement and management process could mean that as many as 17,000 additional people could receive kidney transplants, while 11,000 additional people could receive heart, lung, and liver transplants.

"That would be up to 28,000 American lives saved every year, and that numberr could be quite a bit higher if it works the way we anticipate it work," Trump said.

Trump said the initiative could generate as much as $4.2 billion in savings each year because the cost of kidney transplants are significantly lower than the long-term costs of kidney dialysis.

As part of the executive order, the Center for Medicare and Medicaid Innovation will release a proposed required payment model and four optional payment models designed to incentivize preventative kidney care, home dialysis, and kidney transplants.

About 200,000 Medicare patients are expected to take part in the models, the Department of Health and Human Services said.

More than 37 million people suffer from chronic kidney disease and more than 726,000 have end-stage renal disease. There are nearly 100,000 Americans waiting on the list to receive a kidney transplant, and kidney disease ranks as the ninth leading cause of death in America, HHS said.

Kidney disease accounts for about $114 billion, or 20%, of all traditional Medicare spending each year, but of the more than 100,000 people who begin dialysis to treat end-stage renal disease each year, one in five will die within a year, HHS said.

"Decades of paying for sickness and procedures in kidney care, rather than paying for health and outcomes, has produced less-than-satisfactory outcomes at tremendous cost," said HHS Secretary Alex Azar, telling the crowd at the signing ceremony that his father suffered from kidney failure.

"Through new payment models and many other actions under this initiative, the Trump Administration will transform this situation and deliver Americans better kidney health, more kidney treatment options, and more transplants," he said.

As part of the executive order, HHS has called for: reducing the number of Americans developing end-stage renal disease by 25% by 2030; having 80% of new ESRD patients in 2025 either receiving dialysis at home or receiving a transplant; and doubling the number of kidneys available for transplant by 2030.

Carmen Peralta, MD, executive director of the Kidney Health Research Collaborative, and CMO at kidney care provider Cricket Health, said it was "exciting to see CMS encourage innovation in a kidney care system that has simply failed patients for too long, while costs have skyrocketed."

"For far too long, the most profitable thing in kidney care has been to place a patient on in-center dialysis," she said. "But what's best for patients is intervening sooner — with early diagnosis, care management to slow progression, support for home dialysis, and time to consider dialysis alternatives such as transplants or conservative care."

The Executive Order also calls for HHS to:

  • Launch a public awareness campaign about chronic kidney disease, which 40% of American patients do not know they have.
     
  • Reform organ procurement and management to increase the transplantable kidney supply.
     
  • Expand support for living donors by paying for lost wages and childcare expenses.

HHS will also encourage the development of wearable or implantable artificial kidneys, through cooperation between developers and the Food and Drug Administration, and provide support for KidneyX, the public-private partnership between HHS and the American Society of Nephrology.

“Today we are taking ground-breaking action to bring more hope to millions of Americans suffering from kidney disease. It's a big deal.”

John Commins is a senior editor at HealthLeaders.


KEY TAKEAWAYS

President Trump says the initiative could save about 28,000 lives and $4.2 billion each year.

The initiative creates payment models designed to incentivize preventative kidney care, home dialysis, and kidney transplants.

About 200,000 Medicare patients are expected to take part in the models.


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