NKF Comments on Government Accountability Office's Home Hemodialysis Report
According to a recent Government Accountability Office (GAO) report, there is a critical need for better education on home dialysis.
In 2010, Medicare began offering payments for Kidney Disease Education (KDE). This benefit allowed physicians and advanced practitioners to be compensated for educating to patients on how to slow the progression of kidney disease, and various kidney failure therapies including transplant, home dialysis, and in-center dialysis. However, the GAO report shows that less than 2% of Medicare patients used the KDE benefit in its first two years and this percentage continues to decline.
The GAO report recommends expanding the KDE benefit to allow other providers to be able to bill for the service and to expand the number of patients eligible to receive the benefit – which is currently only available to chronic kidney disease (CKD) stage 4 patients. NKF agrees with this recommendation and has championed the passage of legislation before Congress, The Chronic Kidney Disease Improvement in Research and Treatment Act (S. 598/HR 1130), to accomplish this.
In addition to this recommendation, NKF believes it is critical that broader Medicare payment reform be addressed to encourage earlier detection of CKD and referral to a nephrologist. Nearly 41% of ESRD patients have not seen a nephrologist prior to initiating dialysis. Without proper specialist care, patients do not have the opportunity to learn about their transplant and dialysis options and pre-select a kidney replacement therapy that best meets their health and lifestyle needs.
Early adopters of CKD management and education have seen increased selection of home dialysis among their patients and fewer hospitalizations at initiation of kidney replacement therapy resulting in lower healthcare costs. NKF has called on Congress to address CKD Medicare payments that would include developing a capitated payment model to nephrologists to improve care for CKD stage 4 patients through care coordination activities, overseeing the delivery of KDE services, and preparing the patient for dialysis or transplantation at the appropriate time. This payment would also be tied to performance on quality measures that align with patient education and outcome goals. To ensure that high-risk patients are being detected before they reach kidney failure, NKF has also called for payment reform in the primary care setting that would better encourage early detection and management of CKD including co-management with nephrologists once a patient reaches CKD stage 4.
In summary, NKF concurs with the GAO recommendations on expanding the KDE benefit, but also highlights the critical need to align payment incentives with earlier detection and management of CKD to ensure patients are well informed, educated, and participate in shared decision making on their kidney replacement therapy options.