Expanding access, supporting research and sustaining medicare is the future of kidney care

April 8, 2016

Published by The Hill Congress Blog
Written by Rep. Tom Marino
April 8, 2016

All too often, national health crises present confounding dilemmas with no clear, obtainable solutions. When faced with terrible diseases that cannot be cured, frightening epidemics that reach our shores, or illnesses that defy previously successful treatments, healthcare providers and policymakers suffer from a universal frustration, despite a willingness to do whatever it takes to fix the problem, if only a solution were within reach.

For years, the nation’s growing epidemic of chronic kidney disease (CKD) and end-stage renal disease (ESRD), also known as kidney failure, has left us with many of the same frustrations. As the number of Americans with these conditions has markedly increased, we’ve found ourselves treading water – trying to ensure access to quality treatment for those who need care, slow the number of new diagnoses, and identify ways to continually improve upon (and fund) life sustaining care.

The numbers are staggering. Today, more than 30 million Americans suffer from CKD, and more than 645,600 have progressed to full-blown kidney failure. Individuals with ESRD require either a successful kidney transplant or dialysis treatments to survive. Those with CKD and declining kidney function need the skilled care, monitoring, and tools to slow the progression of their disease, or sometimes even stop it. Continued progress in kidney care relies upon decades worth of research, evidence-based findings, essential medications, and collaboration among healthcare providers to be successful.

The past several decades, although challenging, have yielded some very hard-fought solutions that could finally help put us on track to get our arms around the problem. With a collaborative plan at our fingertips, it is time Congress enacts meaningful legislation that will continue the positive advances we are seeing in kidney care while also ensuring that we maintain the integrity of Medicare’s ESRD benefit which currently cares for a majority of individuals with kidney failure.

Pending legislation — the Chronic Kidney Disease Improvement in Research and Treatment Act (H.R. 1130/S. 598) — offers us this chance. With a bipartisan list of 59 cosponsors in the House of Representatives and a focus on access to pre-dialysis education, improved care coordination, and better coordinated research, the bill will be a catalyst for improving quality of life for a diverse and growing kidney patient population in a way that is fiscally sound and clinically effective.

For patients, the benefits of this legislation are multi-faceted. Most ESRD patients are not only struggling with their failing kidneys, but also with other complex medical conditions like diabetes, cardiac disease, and hypertension, among others, which contribute to kidney failure. Successfully managing these co-morbidities is complicated and requires communication among various treatment providers. When done correctly, care coordination yields improved health outcomes, reduced hospital admissions, and lowered healthcare expenditures. This allows patients to focus on getting better rather than deal with additional stresses.

Unfortunately, the Medicare ESRD program of yesteryear makes such care coordination exceedingly difficult. Whereas under this new legislation, patients would be able to enroll in Medicare Advantage (MA) plans, which many health policy experts argue are best able to serve the needs of medically complex populations by coordinating and managing their multiple chronic conditions. In addition, the legislation would spark exploration of new models of care coordination.

Patients also benefit from increased access to pre-dialysis education and medical care. As an important step toward better outcomes, it would make the pre-dialysis Kidney Disease Education program accessible to more beneficiaries. It would also provide nephrologists and other non-physician health professionals incentives for working in underserved rural and urban areas where a large number of patients currently have to travel long distances – often several times per week – to receive the care they need to survive.

The legislation also recognizes the importance of using new technology, such as telehealth services, and exploring new avenues of research. This will continue progress toward better health and quality of life for individuals living with kidney disease and kidney failure.

Each passing day presents us with more complex policy problems to keep the health of our nation strong. So when we are presented with a solution for one of the most long-standing, expensive and complicated healthcare issues we face, it is incumbent upon Congress to seize the opportunity. Supporting the Chronic Kidney Disease Improvement in Research and Treatment Act is a critically important step toward a healthier nation, and a healthier Medicare.

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