President Donald Trump recently launched his ‘Advancing American Kidney Health’ Initiative.
In this statement, the President addressed several conditions of concern when it comes to American health care including kidney disease. Of the 100,000 Americans who begin dialysis to treat end-stage renal disease, one in five will die within a year.
According to the statement, the Trump Administration is committed to changing this outcome by putting a detailed plan into place.
The Initiative’s Goals
About 40 percent of Americans do not know that they have chronic kidney disease.
Part of President Trump’s plan is to launch a public awareness campaign. The goal is that by 2030, the number of Americans who develop end-stage renal disease will decrease by 25 percent.
In addition, patients need more treatment options, including home kidney care by 2030. The initiative outlines that we should see an 80 percent increase of new ESRD patients either receiving dialysis at home or receiving a transplant.
Currently, organ procurement is heavily regulated. In the past, a large percentage of usable organs have gone to waste each year.
In response, the administration’s program will streamline this procurement system. The plan seeks to clearly define organ viability standards and end geographic disparities in who gets a new organ. The initiative details that the number of available kidneys that can be transplanted should double by 2030.
The initiative also addresses the health care costs of kidney disease. In the plan, the CMS and CMMI proposed new payment models. The goal for these four payment models is to steer kidney patients toward transplants. In order to do so, more transplantable organs need to be made available to eligible patients. The plan also seeks to make other kidney treatment options available to patients.
One of these payment models is ESRD Treatment Choices. The CMMI plans to enroll at least half of America’s dialysis providers in this new program. The hope is that the new payment model will encourage the shift towards at-home dialysis. The goal is to move the more than 500,000 people on dialysis to less expensive in-home care.
The administration hopes CMMI’s optional payment models will incentivize Medicare providers to be more personal and patient-focused as well as to encourage providers to actively work to prevent kidney disease.
One way for this to happen is to encourage doctors to treat patients earlier. As a result of these funding changes, HHS expects to have more than 200,000 Medicare patients enrolled in this new arrangement. It will officially run from January 2020 through December 2023.
The President’s Executive Order laid out specific areas of the plan that will be executed by HHS:
First, the executive order increases HHS’s financial support to living donors. Living donors go through an intense application process. They are often left with significant nonmedical costs, including an average of $2767 for their travel expenses.
This new plan would require HHS to cover their lost wages and child/elder care costs during the transplant process. In addition, HHS has also been charged with improving CMS’s ESRD payment policies.
Second, in order to provide patients with more kidney treatment options, HHS will also be increasing its’ support of KidneyX. As part of this partnership, urgent steps will be taken to spotlight patients’ needs and provide new products to help them.
HHS will also encourage developers and organizations like the FDA to continue developing wearable or implantable artificial kidneys. The President also wants HHS to work with KidneyX to use more prize-based competitions. These events will incentivize the development of new tools for preventing, managing and treating kidney disease.
Third, the executive order tasks HHS with taking serious steps toward making more transplantable kidneys available for patients. One way this will happen is by investigating inconsistencies and underperformance of some Organ Procurement Organizations. Once the kidney evaluation system has been improved, more kidneys can be recovered and used by transplant centers.
The Centers for Disease Control and Prevention currently work to help track and detect chronic kidney disease throughout America. However, the executive order asks HHS to take steps to improve the collection of these metrics.
Specifically, HHS will improve awareness of key risk factors and study and apply more evidence-based prevention. HHS will also develop a plan for even earlier diagnosis and treatment. In addition, HHS will work with NIH research to continue to find ways to develop kidney precision medicine.
The administration wants to see that there is aftermath treatment readily available and accessible to dialysis patients during disaster situations. With that in mind, HHS will work with the Assistant Secretary for Preparedness and Response (ASPR) to develop portable dialysis options for these patients.
Finally, HHS will begin taking patient preferences into consideration, specifically in regard to new kidney disease treatments. These patient preferences will be gathered through patient surveys that the FDA is developing.
What does this mean for you and your teams?
The truth is, we don’t know anything for sure.
But what we do know is that funding will be allocated for living donors. This action goes along with the administration’s effort to encourage more donors to complete the application process. This new financing will hopefully make more transplantable organs available to more patients.
As the government evaluates and streamlines the kidney transplant process, OPOs will have a better system to measure organ offers. Organizations will be looking for tools and processes that will help create new procedures for improving organ viability.
It is often worrisome when government gets involved in allocation. But we expect that as the transplant referral rate grows, transplant centers will be able to adapt to these changes.
Right now, transplant centers focus more on transplant rates and the number of inactive patients on waiting lists. If waiting lists are reduced, workloads will also be reduced. This is key since transplant centers are responsible for each transplant one year after each surgery.
A significant amount of the plan’s funding is being allocated to research and education.
An additional focus is being placed on dialysis and pre-dialysis treatment. This is in response to President Trump’s goal to keep people healthier longer and to make care more affordable. He wants to move patients out of costly dialysis centers and increase transplants.
How can you prepare?
We know these changes will impact the transplant industry. Here are three ways organ transplant teams can prepare for these changes:
1. Stay informed on living donor information.
President Trump’s call for increased financial support includes providing living transplant donors with childcare and eldercare, and lost wages. Make sure you are up to speed on this new funding formula so you can share this information with your living donors.
Also, know that this new financial support could increase the number of transplants. Prepare your teams for this.
2. Stay current on allocation rules.
It is important to stay current on allocation rules. When liver allocation changed, half of transplant centers didn’t know.
Here is a recent UNOS policy update. As of May 24, 2019, the OPTN liver allocation policy has gone back to the liver distribution policy. This policy uses boundaries based on donation service areas and regions. As a result, liver candidates with exception scores are assigned MMaT scores based on recent transplants performed in their donation service area.
This policy change was made to be fairer to patients nationwide and to reduce pre-transplant deaths. This change will also make transplants available to children who need them.
3. Prepare for more referrals to your center.
As the President’s program streamlines the procurement system, it would be wise to consider the possibility that there will be an increase in referrals. Do you have a plan for managing the expected increase?
The current referral process is often ad hoc, with each hospital requiring different entrance criteria and waitlist approval processes. Bi-directional communication is now a must for transplant centers. This will require improved communication.
How is your current communication process working throughout your transplant center and team, and with all external parties? Is it breaking down or inefficient?
It doesn’t need to be. You can improve communication in order to keep up with the changes President Trump’s initiative will bring.
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