Since 1972 the Medicare ESRD benefit pays for dialysis by paying dialysis facilities a bundled payment meant to cover the costs of delivering dialysis treatment.
While dialysis replaces kidney function for more than 550,000 patients, it is a treatment, not a cure, for kidney failure. The five-year survival rate is only 35% - approximately half that of the survival rate for all cancers. According to the United States Renal DataSystem (USRDS), for dialysis patients aged 66-74 mortality rates are more than twice as high for dialysis than for heart failure and more than three times as high as cancer. Beyond mortality, dialysis takes a significant toll on quality of life, causing side effects such as fatigue, pain, bone disease, blood clots, and infection.
To change the current model and realign incentives, NKF focuses our advocacy efforts and policy priorities on public health, early intervention, slowing the progression of kidney disease, increasing options for the treatment of kidney failure beyond the in-center dialysis model, and increasing transplantation. While we support increased flexibility and innovation in the delivery of dialysis care, we believe that continuing to prop up a dialysis-centric model of care is not in the best interests of current and future kidney patients.
When we do engage on dialysis-specific issues, our focus is on assuring high quality care for kidney failure patients. This includes ensuring that patients are empowered and their rights are protected via programs such as conflict free options counseling and psychological and emotional wellness support. We seek to promote innovation through removing barriers to home dialysis and working to make staff assistance available for home dialysis. We want to incentivize patient-centered dialysis care that manages and minimizes side-effects and offers care coordination to manage comorbidities and reduce hospitalizations while still maintaining patient independence and choice. We are inherently skeptical of further healthcare consolidation in the provision of dialysis and support CMMI models that test new ways of paying for quality dialysis care.
NKF advocates for increasing treatment modality options through supporting innovative technology and modality choice.