For those of us working on behalf of the millions of Americans with kidney disease and kidney failure, it’s a proud fact that we’ve come such a long way in a relatively short period of time.
Before the “artificial kidney” was developed and introduced to the United States in the 1950s, patients died when their kidneys failed. Even after the arteriovenous shunt was created in 1960 — making routine hemodialysis possible — the lifesaving therapy was expensive, not covered by insurance, and rationed by committees of laypeople who effectively decided which patients would live and which would die.
Then, in 1972, Congress made an astounding and lasting commitment to Americans with kidney failure by developing the End Stage Renal Disease benefit under Medicare. By doing so, Congress said that kidney failure was no longer equal to a death sentence, and any American –—regardless of age –— could depend on Medicare for their dialysis care.
More than 40 years later, the devastation of a kidney failure diagnosis is the same, but a community of passionate caregivers, patients, advocates and policymakers is more committed than ever to making sure quality treatment helps patients survive and thrive despite their illness.
A critical element of ensuring good outcomes, availability of care and quality of life, is good policy that keeps pace with the changing times.
The kidney community has come together in support of important legislation that, we think, will be another game changer in the history of kidney care. The Chronic Kidney Disease Improvement in Research and Treatment Act of 2014 would support solid clinical research, establish economic stability for the Medicare ESRD Program and, most importantly, improve patient care and treatment options.
The time to make these critical changes is now: a new study shows that 59 percent of all Americans are at risk for developing kidney disease in their lifetime. Another 135.8 million have, or are expected to develop chronic kidney disease during their lifetime. Fewer than 50 percent of people with Chronic Kidney Disease have even been properly diagnosed, making them extremely vulnerable to kidney failure.
The bill would support clinical research and patient education so that — hopefully — fewer Americans will progress from Chronic Kidney Disease to full-blown kidney failure. Knowledge is power, and advancing the care and treatment of patients relies on solid clinical research. Unfortunately, current research on kidney failure disease is terribly fragmented, and critical areas for research and examination that could save and improve lives are not being addressed.
Successful passage of this legislation would allow the Government Accountability Office to identify gaps in current research efforts and require an interagency committee to issue public reports that include a strategic plan and a portfolio analysis on research projects. And because kidney failure disproportionately affects minority populations, part of that research would, importantly, examine the social, behavioral, and biological factors leading to kidney disease and kidney failure, while aiming to develop methods to slow the progression of kidney disease and kidney failure in these populations.
Just as essential to the continued success of Medicare’s ESRD benefit — and the long term health of its patients — is maintaining a fiscally sound program that is responsible, sustainable and cost effective. The kidney community knows we can achieve this by adopting smart payment policies to ensure adequate reimbursement rates that properly reflect the costs of providing care services.
This promising legislation would address the widespread — and growing — nature of the kidney disease epidemic. Kidney disease and kidney failure know no boundaries, and currently there are areas of the United States with an alarming lack of providers to care for the patient population. The legislation would incentivize professionals caring for patients in underserved areas, ensuring these vulnerable populations receive the quality care they need on a routine basis – since foregoing care because of lengthy travel or inconvenience is incredibly dangerous and even deadly.
It would further improve patient access to care by expanding coverage choice for patients in need of dialysis care. It would allow patients to maintain their own private insurance for a longer period of time before enrolling in Medicare. And it allows patients greater choice in care offerings including enrolling in Medicare Advantage plans and a new coordinated care program.
Kidney care has come a long way, but we simply cannot rest – particularly at a time when so many Americans are in need of lifesaving care. The time is now for passage of Chronic Kidney Disease Improvement in Research and Treatment Act of 2014, and the benefit it will surely bring to patients, Medicare and taxpayers alike.
Dr. Edward R. Jones is chair of Kidney Care Partners.