The National Kidney Foundation (NKF) does not believe the Senate Finance Committee’s Bipartisan Chronic Care Working Group (CCWG) recommendations go far enough to address the growing numbers and needs of Americans with chronic kidney disease.

On January 29^th, NKF released comments on the CCWG’s policy options document. The working group, chaired by Senator Isakson (GA) and Senator Warner (VA), made numerous proposals to improve the care of Medicare beneficiaries with chronic conditions and to lower healthcare costs.

While NKF is pleased with proposals to improve the care of individuals with end-stage renal disease (ESRD) who are on dialysis, NKF also urged the CCWG to target Medicare payment reforms that will encourage better care for individuals with chronic kidney disease (CKD). Only by diagnosing and managing CKD early can we save lives, improve outcomes for kidney patients and reduce healthcare spending.

Today, 38% of individuals start dialysis without seeing a nephrologist prior to kidney failure. Although CKD is a progressive disease, most of these individuals did not know they had it prior to their kidneys failing. This is a clear indication that we are failing to manage a chronic condition in tens of thousands of Americans who have easily-identifiable CKD.

CKD is the 9^th leading cause of death and places patients at an increased risk for heart attack, stroke, acute kidney injury and other costly comorbid conditions. CKD costs Medicare $99 billion each year. Only by making chronic kidney disease a public health priority, can we begin to reduce these startling numbers.

To meet the working group’s goals to improve care coordination across settings of care and lower spending, NKF recommends a four step approach to support practitioners to detect and manage CKD and hold them accountable for improvements in kidney care. These recommendations build upon and refine NKF’s proposal sent to the CCWG last summer.

• Direct the HHS Secretary to develop a bundled payment tied to quality metrics that would facilitate primary care practitioners (PCPs) to detect at-risk patients for CKD and manage their CKD population.
• Direct the HHS Secretary to bundle payment to nephrologists for CKD stage 4 care planning tied to quality metrics.
• Allow nephrologists, PCPs, and other clinicians that adopt these bundled payments to form organizations and collaborate with each other and other practitioners to improve outcomes for patients with CKD.
• Direct the HHS Secretary to develop and implement quality measures, designed to improve CKD care, to support these CKD specific payment models and that can also be incorporated into other alternative payment models and quality improvement programs.

NKF also expressed support and provided insight on several other proposals by the Working Group, including:

• Allowing Medicare beneficiaries with ESRD to enroll in Medicare Advantage plans and elect to change plans yearly as other Medicare beneficiaries are permitted to do.
• Permitting home dialysis patients to meet with their nephrology practitioners monthly from their home using telehealth video technology (i.e., a video enabled smartphone or tablet).
• Getting Medicare coverage for the Diabetes Prevention Program so that more Medicare beneficiaries have access to this program that has been proven to prevent diabetes and its complications, including kidney failure.

NKF is America’s largest and long-established health organization dedicated to the awareness, prevention, and treatment of kidney disease. We work with volunteer experts to offer the scientific, clinical and kidney patient perspective on what needs to be done to prevent kidney disease, delay progression, and better treat kidney disease and kidney failure. For more information, visit www.kidney.org