Americans with Kidney Failure Among the Most At-Risk; Cannot Miss Dialysis Care

WASHINGTON – As the nation works to contain COVID-19 virus, the kidney care community urges Congress and the Administration to act quickly to protect individuals with chronic kidney disease (CKD) and end-stage renal disease (ESRD), as well as the caregivers who ensure dialysis facilities can remain operational during the emergency.

For the more than 37 million individuals living with CKD and ESRD, social distancing and avoiding medical facilities is not an option. These individuals are often vulnerable and have multiple chronic conditions to manage and those with ESRD depend on multiple dialysis treatments per week, in most cases in-person, to survive.

“COVID-19 has already shown that no American is immune to this virus, but we must remember that patients with CKD, ESRD and transplants are particularly susceptible,” said John P. Butler, Chair of Kidney Care Partners (KCP). “These Americans have multiple comorbidities and are often immunosuppressed, which puts them at greater risk. We hope Congress and the Administration will act soon to protect their health and the ongoing safety of the caregivers who treat them.”

Kidney care providers, who continue to care for their patients, are on the frontlines of care during this crisis. By maintaining current coordinated care programs for these individuals, providers can help patients avoid costly hospital re-admissions at a time when the healthcare system is overwhelmed by new COVID-19 cases.

Recent analyses of data from China, Italy and Washington state show individuals with CKD and ESRD may face higher morbidity and mortality rates from COVID-19 than the general population. Providers are implementing emergent healthcare protocols to mitigate this potential increased risk, including increased patient screening and evaluation, isolation and separation of patient and clinical staff to avoid potential spread and additional dialysis shifts to accommodate patient needs. These protocols all require increased staffing and resources.

“KCP is committed to keeping our patients and providers safe and healthy during this national emergency, but we need action from policymakers to help us weather the crisis,” said Butler.

Specifically, KCP – a coalition of patient advocates, dialysis professionals, care providers, researchers, and manufacturers dedicated to working together to improve quality of care for individuals living with kidney diseases – is asking Congress and the Administration to:

• Provide supplies and capacity support – Ensure access to Personal Protection Equipment (PPE) and other medical supplies for the safe treatment of patients infected with COVID-19, and ensure that dialysis facilities are prioritized in distribution. Additionally, provide assistance for developing temporary dialysis facilities for those infected with COVID-19.
• Expand the use of telemedicine – KCP requests that CMS make technical coding changes to allow telehealth service to be provided to patients dialyzing at home.
• Provide authority and resources for patient assistance – The COVID-19 crisis is interrupting wraparound services for patients with ESRD, such as transportation and nutrition. Non-profit organizations, such as the American Kidney Foundation and the Renal Support Network, are assisting patients with such services through various grant programs, but funding is limited and current regulations prevent programs from working efficiently. To assist these organizations, Congress should provide a temporary safe harbor from Stark, Anti-Kickback, fraud and abuse statutes for non-profit organizations and health providers to facilitate patient assistance programs and provide grants to eligible non-profit entities to enhance COVID-19-specific patient assistance programs. In addition, KCP seeks waive restrictions on dialysis facilities and nephrologists to allow them to provide or facilitate patient assistance programs for patients who need financial support for food, medicine, co-payment obligations or other expenses during the emergency.
• Waive regulatory requirements that can delay patient care – CMS should lessen the regulatory burden for providers by waiving staffing ratios and patient transfer requirements.
• Expand access to home dialysis – Provide reimbursement for urgent-start PD programs, staff-assisted home dialysis when patients are placed in exposure risk when traveling, as well as immediate approval for SNF staff-assisted home dialysis in areas when the required documentation has been submitted but has not yet been approved. 
• Facilitate home treatment options – Provide coverage under Medicare Part D for oral agents indicated by the FDA to treat conditions associated with CKD in patients not on dialysis, such as for an oral anemia therapy, if they would allow patients to avoid infusion treatments in hospitals, minimize risk of exposure, and adhere to shelter-in-place orders. 
• Delay ESRD Treatment Choices Pilot Program – CMS should delay the implementation of new models while providers work to address the current crisis.
• Provide financial relief to health care providers caring for patients on dialysis – Providers of dialysis are facing severe challenges related to workforce shortages, greater demands in supplies and equipment and patient support services. Providers are looking for 100 percent reimbursement of “bad debt” under the ESRD PPS and access to any provider stabilization fund enacted by Congress for emergency expenses.

“We realize that Congress and the Administration are working tirelessly to support the health and economy of our nation amid the COVID-19 emergency and we hope they include targeted support for America’s dialysis patients and workforce,” concluded Butler. “The kidney care community stands ready to work together during this crisis and hope policymakers will stand with us as well.”

###