CMS Proposes New At-Home Dialysis Incentive in Wake of COVID-19 Pandemic

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The agency plans to pay more for Medicare beneficiaries to use dialysis equipment at home, with the aim of moving more treatment away from dialysis centers in light of the COVID-19 pandemic. This is positive news for home dialysis companies, as capital-related assets were left out of the agency’s October 2019 rule, and for nephrologists, although barriers to implementation remain.

Just over a year ago, the White House outlined key goals for renal care in an executive order, the Advancing American Kidney Health Initiative, and HHS Secretary Alex Azar unveiled Kidney Care First and three Comprehensive Kidney Care Contracting models. A major component of the policy was ensuring that 80% of all new dialysis patients start therapy at home or received kidney transplants by 2025. However, since then, advancing the Initiative’s concepts to the point of a federal rulemaking has proved to be difficult. Dialysis industry leaders challenged the mandatory model that was proposed, the End-Stage Renal Disease Treatment Choices Model, and the new rule that was to take effect in January 2020 stalled before it got off the ground. (See “Advancing American Kidney Health: Will a New Executive Order be a Game-Changer for ESRD?” Market Pathways, August 19, 2019.)

Then, the world was hit with COVID-19. ESRD patients began landing in the hospital with the virus, and many of them did not fare well once they got there. According to CMS, this population already faces one of the highest hospitalization rates among Medicare patients, as they often have multiple chronic conditions and comorbidities. And, they are at a higher risk of contracting COVID-19 due to their mandatory dialysis sessions. More than 85% of the 550,000 US Medicare ESRD patients travel to a dialysis center at least three times per week, spending an average of 12 hours a week receiving the life-sustaining treatment. This highlights the importance of this population finding treatment alternatives to reduce risk of exposure to the virus. To add to this already challenging issue, COVID-19 has also been found to cause acute kidney injury among those with no prior history of renal problems, as well as damage to the heart, lungs, and other organs. Thus, not only is the pandemic adding pressure to the already-taxed health system, as millions of patients globally battle the novel coronavirus, it is creating new groups of patients who may need dialysis once they recover.

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