Nation’s Largest Kidney Coalition Prioritizes, Advances Key Policies to Promote, Support Home Dialysis Care, Choice, Quality

August 23, 2021

Kidney Care Partners Advocates for Patient-Centric Home Dialysis Policies with Quality Measure Development; Bipartisan Legislation; and Regulatory Reform to Remove Silos, Promote Innovations

WASHINGTON – Kidney Care Partners (KCP) – the nation’s largest kidney care coalition comprised of 35 organizations, including patient advocacy groups, medical and transplant professionals, manufacturers, providers, and researchers dedicated to working together to improve quality of care for individuals living with CKD, end-stage renal disease (or kidney failure), and kidney transplants – today reiterated its support for and highlighted momentum on access to home dialysis care and services.

KCP remains committed and focused on new policies and programs organized through Congress, the Administration, and the broader kidney care community to advance increased access to and utilization of home dialysis as a choice in kidney care.

“We, as a diverse and unified community, remain committed to working collaboratively with policymakers to improve access, choice, and equity in kidney care,” said John P. Butler, chair of KCP. “We must continue to pursue novel ways to meet patients where they are and eliminate persistent barriers to care. To do so, we need to work collaboratively with all stakeholders to expand access to home dialysis, including advancing bipartisan legislative efforts in Congress to support choice and access to quality kidney care in America.”

Home Dialysis Remains 2021 Community Issue Priority

In 2018, KCP engaged in community workgroup sessions to promote and advance home dialysis care and choice, specifically in the development of policies to remove barriers for patients selecting home dialysis. Recommendations included the expansion of the Medicare Kidney Disease Education (KDE) benefit, removing regulatory barriers to coordinating patient care and promoting education between providers and facilities, as well as supporting activities to increase home dialysis.

This year’s priorities focus on a targeted set of patient-centric policy objectives, including eliminating barriers to patient access for new and innovative treatment options for dialysis patients and expanding access to not only home dialysis but also kidney transplants.

Kidney Care Quality Alliance Re-Launched to Address Home Dialysis, other Key Areas

KCP recently announced the reconvening of the Kidney Care Quality Alliance (KCQA) to develop dialysis-facility level performance measures specifically for use in federal ESRD quality programs such as the ESRD Quality Incentive Program (QIP), Five-Star Program, and now the ESRD Treatment Choices (ETC) Model. The two-year effort aims to create dialysis facility-level performance measures that are evidence-based, empirically sound, and community-supported; that appropriately address social risk and health inequities; and that effectively meet the unique needs of dialysis patients, providers, other members of the kidney care community, and federal policymakers. KCQA is guided by a 15-member Steering Committee convened to design quality measures that can be used to incentivize quality improvements in home dialysis care and outcomes.

Once consensus is reached, KCQA will test and review the home dialysis measures and will then seek third-party endorsement by the National Quality Forum and adoption of the measures into CMS’s ESRD QIP and ETC Program as official measures for providers participating in the nation’s Medicare program.

Addressing Health Inequities in Kidney Care, Improving Access and Choice in Dialysis Care Modalities

During the last several years, KCP has actively engaged with policymakers in Congress and the Administration to remove access barriers that make it more difficult for patients who want to select home dialysis to do so. KCP is pleased the Biden Administration has prioritized encouraging more Medicare beneficiaries who require dialysis to select home dialysis modalities.

As the Government Accounting Office (GAO) has noted, there are many reasons that patients may not select these modalities, most of which center around socio-economic issues. As the 2015 GAO report noted, the Medicare KDE benefit is not effective today, in large part, because of its inadequate payment rate. CMS should ensure adequate payment for the benefit and emphasize modality education as part of it. Also, while dialysis facilities are well equipped with the interdisciplinary beneficiary teams to provide the benefit, current law limits which medical professionals can offer the benefit. CMS should address this problem by piloting a KDE benefit program that allows dialysis facilities to provide and be reimbursed for KDE services and evaluate its impact on the number of beneficiaries who select home dialysis.

Continued Support for Innovation and Virtual/Telehealth Care Options

Support Federal Policies to Address Barriers

KCP recognizes that there are steps the federal government can take to help address these barriers, which were shared in a recent letter to the Office of Management and Budget and included the following recommendations:

  • Make the current telehealth waivers permanent for individuals who receive dialysis.
  • Collecting social determinants of health data using Z-codes to account for and report on the most common non-clinical barriers to home dialysis, including housing or financial insecurity, minimal caregiver support, other mental and certain physical illnesses, or advanced age to provide information about these barriers, develop policies to overcome them, and to be able to set target rates of home dialysis adoption.
  • Creating incentive payments for nephrologists and facilities linked to home dialysis adoption.
  • Increasing the physician payment for home training from $500 (which has been the rate for more than 30 years) to $1,750, which is the $500 amount updated for current dollars. The initial $500 could be paid at the outset, while the increase of $1,250 could be paid out after a patient has completed six months of successful home dialysis treatments.
  • Eliminating barriers created by ESRD QIP and DFC/Five Star measures to allow for more transparency for patients seeking home dialysis performance information.
  • Specifically, eliminate the pooled adequacy of dialysis measure and replace it with the four individual dialysis quality measures to allow patients to see facility performance on home and pediatric dialysis, rather than have them rolled up in a single measure that disincentivizes the use of home dialysis. This is the task that KCQA is currently engaged in addressing.

“We are committed to developing and advocating for policies to promote and encourage innovation in home dialysis. Specifically, KCP will work to eliminate barriers to the long-term adoption of innovative products and services in the ERSD Prospective Payment System (PPS) and Medicare Advantage (MA) program,” added Butler. “We will also continue to support important efforts to increase both NIH funding for kidney disease research and expanded funding for KidneyX. The commitment and momentum among policymakers and our community are closely aligned on these critical areas involving improved quality, access to innovations and care settings, and equity in kidney care.”