Supporting Home Dialysis
Home dialysis is a viable treatment option for many individuals with ESRD, but individuals face a series of practical barriers that, unless addressed, will prohibit them from being able to opt into dialyzing in the home. These include the lack of a care partner, inadequate space for the home dialysis equipment and supplies, problems with housing, lack of access to nutritional food and meals, mental health issues, and lack of transportation.
KCP believes that individuals who want to choose home dialysis should be able to, and we support policies that address barriers to offer individuals that opportunity. We recognize that some individuals need support that goes beyond current Medicare reimbursement rates, and KCP encourages HHS and CMS to explore supplemental programs to better meet these individuals’ needs.
However, KCP also recognizes that home dialysis is not the right choice for all individuals and supports guardrails to ensure incentives to increase home dialysis do not override clinical appropriateness and that patient and physician voice be in the forefront in choosing a care setting. Some may fear being placed on home dialysis when it may not be the clinically appropriate option for them, and the ESRD Treatment Choices (ETC) model has increased this fear.
The Kidney Care Quality Alliance (KCQA) has developed a measure set that includes a home dialysis rate measure coupled with a retention measure that would incentivize clinicians to make sure that people who are initiated on home dialysis are supported to stay on home dialysis long-term. KCP encourages CMS to support endorsement of this measure set by the National Quality Forum (NQF) so that it can be incorporated into the ESRD quality measurement programs.
KCP Comment Letters & Resources:
- Letter to the Center for Clinical Standards & Quality at CMS Regarding Home Dialysis and Transplant Measure Sets (April 14, 2023)
- KCP Response to CMS Request for Information on Health and Safety Requirements for Transplant Programs, Organ Procurement Organizations, and End-Stage Renal Disease Facilities (January 28, 2022)
- Kidney Care Quality Alliance: Home Dialysis Measure
- Comments on the CY 2022 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Proposed Rule (August 26, 2021)
- Comments on the CY 2021 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Proposed Rule (September 3, 2020)
- CY 2020 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Proposed Rule (September 11, 2019)