Congress, the administration, and kidney care community must further improve care for 30 million Americans
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March is National Kidney Month, a perfect time to reflect on the progress made in kidney care and efforts to advance that success to the next level. The challenge facing individuals with kidney diseases requires a united effort from Congress, the Administration, the National Institutes of Health (NIH) and the kidney care community. Fortunately, the collective commitment and momentum are in place, and now is the time to seize on this opportunity to maintain this forward trajectory.

More than a decade ago, the kidney care community set an ambitious goal to improve patient care outcomes and reduce health care costs. We have made significant strides in advancing kidney health with numerous multi-disciplinary work groups consisting of clinicians, providers, patient groups, researchers and manufacturers working together to: develop performance measures for accountability and endorsement through the National Quality Forum process; undertake a successful initiative to improve survival in the first year of dialysis; establish a strategic “quality blueprint” that identifies the leverage points for quality improvement; and publish a framework for considering patient reported outcomes (PROs) in this vulnerable population.  All of these initiatives challenged us as a community while we worked constructively with policymakers on meaningful programs and policies that advance us toward the common goal of higher quality care and quality of life for patients with kidney diseases. 


Now, a new analysis by Discern Health, which examined data from the government’s United States Renal Data System (USRDS), confirms that patient outcomes have significantly improved during the past decade. All-cause dialysis mortality rates have fallen, as have hospital admission rates for individuals who rely on dialysis care for long-term care needs or while they await a kidney transplant. In fact, gains in survival rates among this population now outpace those for cancer, heart disease, diabetes, and many other serious chronic diseases. Incredibly, the gains in kidney care come even as some chronic diseases saw worsening mortality – heart failure and myocardial infarction among them.

Despite the fact that individuals with kidney failure are among the most complex and costly Medicare beneficiaries to treat, improvements in dialysis care have led to substantial cost savings for Medicare. Discern Health confirmed that Medicare’s spending growth on individuals in kidney failure slowed from 7 percent to 1.5 percent over a 10-year period. These savings persist even after accounting for the fact that the number of Americans who require dialysis has risen sharply in the last few decades, and are now in the billions of dollars.

The kidney care community’s and policymakers’ efforts to advance access, choice, and quality while maintaining the integrity of the Medicare ESRD benefit have had positive, measurable results, yet there is still much more room to improve. We can—and must—do better to build on the real gains we’ve made, and focus on other critical areas such as prevention, access and choice, and increased investment in research and innovations.

In order to challenge ourselves again, we need a bigger and bolder agenda aimed at further boosting survival rates, focusing on patient-centered care and quality of life, improving access to treatment, investing in innovative therapies and medicines, and ensuring kidney health is more effectively addressed before individuals reach kidney failure. 

This ambitious agenda requires working collaboratively with policymakers and other stakeholders through public-private partnerships to achieve even greater gains for kidney health. Any constructive collaboration must address not only quality and innovation but also the chronic Medicare underfunding as reported by the independent, nonpartisan Medicare Payment Advisory Commission (MedPAC) in January.  This is particularly concerning in the ESRD program as approximately 85 percent of patients rely on government funding for their care.

Last year, the kidney community held a briefing on Capitol Hill with leaders from the kidney care stakeholders, bipartisan members of Congress, and senior representatives from NIH and CMS to share a bold vision for kidney care in America and commit to improving the lives of the tens of millions of Americans living with kidney diseases.

As strong supporters of value in the U.S. health care system, we commend Department of Health and Human Services Secretary Alex Azar’s efforts to foster even greater improvements for the 30 million Americans living with ESRD. Our shared commitment to programs like the Kidney Innovation Accelerator (Kidney X), which is running a competition to develop the new generation of advanced kidney care technology, underscores our commitment to continuously improving kidney health. In addition, we strongly support the interests of HHS and the Center for Medicare & Medicaid Innovation in advancing the care for individuals with chronic kidney diseases before kidney failure occurs, and for significantly increasing the number of patients receiving dialysis at home or a kidney transplant.

The administration has already shown a welcome focus and dedication to prioritize policies and programs to address disease affecting millions of Americans. Secretary Azar vowed in remarks to the National Kidney Foundation that “together, we can deliver much better care, and longer lives, for Americans with kidney disease.” In Congress, a bipartisan group of lawmakers in the House and Senate are working on an updated version of the 2018 Chronic Kidney Disease Improvement in Research & Treatment Act that will be introduced later this year.

As someone who has been a practicing nephrologist for more than 40 years, it is exciting to see the community standing shoulder-to-shoulder with the policy community.  We are excited to do our part to advance this bold agenda with a renewed and reimagined commitment to innovation.

To that end, we look forward to continued collaboration with policymakers in Congress and the administration to further help patients with chronic kidney diseases, kidney failure and transplants live longer, healthier, and more fulfilling lives.

Nissenson is chair of Kidney Care Partners.