White House

Trump unveils sweeping goals on kidney disease

Executive order aims to improve quality and cut costs by refocusing care on prevention

President Donald Trump arrives for a rally in Montoursville, Pa., on May 20, 2019. Trump on Wednesday outlined an agenda to improve preventive treatment of kidney disease. (Tom Williams/CQ Roll Call file photo)

President Donald Trump outlined an agenda to improve preventive treatment of kidney disease Wednesday, zeroing in on a condition that afflicts more than 30 million Americans and costs more than $100 billion in annual Medicare spending.

The executive order Trump signed aims to improve quality and cut costs by refocusing care on prevention. The initiative’s overarching goals are to reduce the number of new patients with end-stage renal disease by 25 percent by 2030, and to have 80 percent of ESRD patients either receiving in-home dialysis or transplants by 2025.

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“I am here to say we are fighting by your side and we are determined to get you the best treatment in the world,” Trump said.

The administration is also looking to double the number of kidneys available for transplant by 2030, in part through a public awareness campaign and by compensating donors for things like lost wages and child care.

“Those people, I have to say, have never gotten enough credit,” Trump said, referring to donors. “What they do is so incredible.”

More than 100,000 patients were awaiting new kidneys in 2016, according to the National Kidney Foundation, making up the bulk of patients awaiting an organ transplant. Health and Human Services Secretary Alex Azar said Wednesday that transplants are the “end game” for kidney patients, noting that half of patients on dialysis die within five years.

The executive order includes the introduction of five new payment demonstrations, including one that will compel providers to participate. The demonstrations will, among other things, create incentives for dialysis providers to offer the treatment in a patient’s home. Center for Medicare and Medicaid Innovation Director Adam Boehler told reporters the models will be “broad and sweeping,” impacting over half the country.

The announcement comes amid reports that Trump will soon nominate Boehler to lead the Overseas Private Investment Corp., which drives private investment in developing economies. Boehler declined to confirm the reports.

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The condition’s price tag is partly why it has become one of the administration’s focal points. Kidney disease accounts for roughly one in five dollars spent in Medicare, totaling $113 billion in 2016. 

The dialysis market also remains highly concentrated, with just two major players — DaVita and Fresenius — dominating it. Delivering in-home dialysis could be a significant cost saver, since just 12 percent of kidney patients begin dialysis at home. 

Centers for Medicare and Medicaid Services Administrator Seema Verma will also be reviewing requirements for organ procurement organizations.

Trump’s speech expanded on a host of initiatives already underway within the administration. CMS is currently testing out a payment model to hold providers accountable for clinical outcomes in return for a portion of savings achieved through the program — roughly $2,000 per kidney patient in 2015. Azar has also previously said the department was looking at ways to modernize payments for patients in the earlier stages of kidney disease.

The National Institutes of Health, meanwhile, is set to begin studying individual variants of the disease as part of its Kidney Precision Medicine Project. A separate study will focus on the APOL1 gene, which frequently complicates transplants for African American patients.

Last year, HHS launched a two-phase competition called KidneyX to spur innovation in dialysis. Fifteen winners announced in April presented ideas to modernize treatments, and contestants in the second stage will be asked to design prototypes. The contest is expected to dole out a total of $2.6 million in prize money when it wraps in January 2020. 

CMS is also proposing to increase a bonus payment for certain innovative technologies, which could include some treatments or devices stemming from the KidneyX competition.

“For decades, across all of American health care and kidney care in particular, the focus has been on paying for procedures rather than paying for good outcomes,” Azar said on a call with reporters. “Under the president’s leadership, we’re working to flip that around.” 

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