©2018 Kidney Care Partners
The Hill Congress Blog
By Dr. Ed Jones
Caring for patients with complex medical conditions is more complicated today than ever before. While we have a variety of state-of-the art treatments, we also have a health care system that is fragmented, inefficient and costly – one that keeps us spinning our wheels when it comes to true progress in managing many diseases and improving the lives of patients.
As a nephrologist working closely with the broader kidney care community for 35 years, I have witnessed tremendous progress. Mortality rates among our most vulnerable patients, those on dialysis, fell by more than 19 percent between 2003 and 2011. Moreover, hospital admission rates among Medicare-enrolled dialysis patients fell by more than 8 percent from 2005 to 2011. This measurable progress came about by working together with the specific objective of improving quality.
Despite these advances, the system could be significantly improved. For patients whose kidneys can’t function on their own, dialysis treatments, combined with carefully managed medical care, save the lives of more than half a million Americans annually. But amid the groundbreaking technologies, medical oversight, and medications keeping these patients healthy, we are sorely lacking in targeted initiatives that expand patient choice and improve care coordination.
Certainly, we have come a great distance when you consider that just 60 years ago, the majority of Americans diagnosed with kidney failure died due to a lack of treatment availability. Since 1972, when Congress enacted Medicare’s ESRD benefit, any American in need of dialysis has been able to receive care. However, fast forward to today, as more Americans than ever need access to this type of care, we find ourselves faced with a host of new difficulties related to a program that is ready for modernization.
Among the most pressing issues faced by the kidney community and kidney failure patients: restricted access to coordinated care, limited patient choice for those in underserved communities, and gaps in biomedical research. None of these issues likely could have been foreseen when the ESRD program was first launched. Fortunately, members of Congress are dedicated to ensuring the Medicare program – and its ESRD benefit – keeps pace with patients’ evolving needs and medicine’s eye-opening advancements.
The Chronic Kidney Disease Improvement in Research and Treatment Act, introduced in the House by Reps. Tom Marino (R-Pa.) and John Lewis (D-Ga.) and in the Senate by Sens. Ben Cardin (D-Md.) and Mike Crapo (R-Ida.), represents a 21st century “tune-up” for a program that has done so much for so many.
Created with a focus on the needs of patients, this groundbreaking legislation expands freedom of choice for individuals with kidney failure. Current law prohibits individuals who develop kidney failure from enrolling in Medicare Advantage (MA) plans, which specialize in the coordination of care for older patients and those with multiple chronic conditions. For individuals with kidney failure, carefully coordinated care is essential, since most patients have multiple chronic conditions, requiring teamwork across several medical specialties. Evidence shows that coordinated care models can and do result in better health outcomes, including reduced hospital readmissions.
In my own experience, I’ve seen that a coordinated care approach results in better health care for my patients. When I am able to work closely with other physicians also charged with the care of the patient, the patient experiences improved outcomes. This bill simply ensures that individuals with kidney failure have access to the same coordinated care options.
The legislation also expands access to kidney disease education programs and, through the use of telemedicine, to home dialysis treatment options. In addition, the bill creates incentives for kidney care providers to work in underserved rural or urban areas.
Ultimately, the development of better treatment options depends upon our ability to better understand kidney disease. The bill’s sponsors have allowed for ways to identify the gaps in research and improve the coordination of federal research efforts, making the best use of precious research dollars. For example, the bill would require a federal report on ways to improve care management and would also facilitate a broad evaluation of biological, social, and behavioral factors that affect care.
Kidney failure is one of the most complex, multi-faceted health care issues facing Americans today, and it is one that requires a multi-faceted approach, if we can expect to keep pace with patient needs. We can’t expect to eliminate kidney failure in the near term, but we certainly should make every effort to work together to improve our knowledge and the care we provide to patients. The Chronic Kidney Disease Improvement in Research and Treatment Act is an excellent step in making the necessary improvements to Medicare’s ESRD program, and my colleagues and I applaud leaders in Congress for their dedication to this issue.
Dr. Ed Jones is chair of Kidney Care Partners, a broad-based coalition of patient advocates, dialysis professionals, care providers and manufacturers dedicated to working together to improve quality of care for individuals with Chronic Kidney Disease (CKD).