By: Michael Choi, MD Immediate Past President of the National Kidney Foundation
In February 2017, shortly after President Trump’s inauguration, The National Kidney Foundation declared that the “Trump Administration Will Know that CKD is a Public Health Priority” and we are excited to say that chronic kidney disease (CKD) is indeed a priority focus for the Administration.
On Friday February 1, The National Kidney Foundation along with other kidney organizations were invited to participate in a small roundtable discussion with Secretary Alex Azar to discuss opportunities to transform kidney care. In his opening remarks the Secretary stated that transforming kidney care and increasing access to transplantation was indeed a priority for him and for the President and that he wanted to hear directly from our organizations on opportunities to improve kidney care. On the Secretary’s list of discussions were key priorities of the National Kidney Foundation including new payment models to improve earlier identification of kidney disease to prevent and delay progression, improve treatment for advanced CKD including a home first approach to dialysis when a pre-emptive transplant is not possible, and increasing access to transplantation, including increasing the supply of kidneys by reducing the number of kidneys that are discarded. The National Kidney Foundation has championed all of these priorities and developed actionable policy recommendations for improvements.
The National Kidney Foundation, working with multi-disciplinary healthcare professionals and kidney patients, developed the CKDintercept alternative payment model, which incentivizes primary care and nephrology practitioners to work together to improve early detection and treatment to delay progression, ease transitions of care for patients who progress and educate patients early on opportunities for a kidney transplant or home dialysis. During the meeting the National Kidney Foundation encouraged the Secretary to adopt these recommendations as it considers new value-based payment models for kidney care; and we sincerely appreciate learning that the Secretary is aligned with these goals.
The National Kidney Foundation was also able to share recommendations from our Home Dialysis Controversies Consensus Conference Series held in November 2017 and November 2018, to study and remove barriers to home dialysis. Patients and health care professionals worked together to develop many recommendations, which included changes to physician payments and suggested changes to Medicare reimbursement for education to increase opportunities for patients to learn about all of their treatment options once they experience kidney failure.
The National Kidney Foundation also shared policy and reimbursement recommendations to reduce the number of kidneys discarded that could have successfully been transplanted giving the patient a longer, higher quality of life than they would have on dialysis. These recommendations came from the National Kidney Foundation’s May 2017 Consensus Conference to Decrease Kidney Discards, which included patients, organ procurement organizations, transplant programs and nephrology practitioners and were published by the Journal Clinical Transplantation online first in October 2018. More than 3600 kidneys were discarded in 2016 and it is estimated half of those kidneys could have been successfully transplanted underscoring the need for significant reforms. We were pleased to hear the Secretary mention kidney discards and state that HHS is exploring opportunities to increase the supply of kidneys so that more patients can benefit from this ideal treatment.
The National Kidney Foundation also voiced our strong support for expanding programs to provide reimbursement of expenses to living donors incurred over the course of donation. Specifically, we thanked the Secretary for the Health Resources & Services Administration’s upcoming pilot to cover lost job wages for living donors that is expected to launch this Summer and we voiced our support for expansion and additional funding for that pilot to cover more living donors and to expand programs, like the National Living Donor Assistance Center (NLDAC), to cover other out-of-pocket expenses such as child and dependent care.
The National Kidney Foundation is optimistic for the future of kidney care and are grateful to the other kidney organizations, American Association of Kidney Patients, American Society of Nephrology, Dialysis Clinics, Inc, and the Renal Physicians Association who also contributed recommendations and emphasized shared goals during the meeting. In addition, to the Secretary, NKF would like to thank Assistant Secretary for Health Admiral Brett Giroir, MD; Deputy Administrator for Innovation & Quality and Director of the Center for Medicare and Medicaid Innovation, Adam Boehler; and Ed Simcox, Chief Technology Officer who participated in the meeting.
The National Kidney Foundation will continue to engage with HHS to advance our recommendations and we greatly appreciate the Secretary’s leadership in making CKD a public health priority.