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Turk: Hemodialysis at Home Is a Better Way for a Better Life

Medicare’s dialysis payment policies discourage health care providers from offering a viable treatment option

More than 570,000 Americans are living with end-stage renal disease, the vast majority of whom are dependent on dialysis treatments to replace kidney function. For some of these patients, home hemodialysis is a viable treatment option that should be available.

Unfortunately, access is severely limited today — largely because Medicare’s dialysis payment policies unintentionally discourage health care providers from even offering HHD. As a result, many qualified patients aren’t adequately informed about all of their treatment options, and less than 2 percent of U.S. dialysis patients enjoy the benefits of more frequent HHD today.

This must change, and the sooner, the better. That’s why NxStage is excited to launch Hemodialysis at Home: A Better Way for a Better Life, a new project to raise awareness about the benefits of HHD and remove barriers limiting access for patients.

Home hemodialysis works. It provides patients with freedom and flexibility that enable them to live a more normal life on dialysis. You don’t have to take my word for it; there are a number of current and former dialyzors out there talking about how HHD changes lives. Physicians and nurses also have gone on record talking about the associated benefits.

In fact, more than 90 percent of nephrologists reportedly say they would choose a home dialysis therapy for themselves, with HHD being the preferred option. Yet, more than 90 percent of patients undergoing dialysis in the United States are doing in-center therapy.

Seems kind of upside-down, don’t you think? This is largely because of barriers that prevent patients from taking advantage of HHD technology.

For example, only 24 percent of dialysis centers offer HHD, and even though Medicare requires that patients be educated on all of their treatment options, only 12 percent of patients report being informed about HHD options.

And while studies show that U.S. nephrologists believe that 10 percent to 15 percent of patients would represent an ideal utilization of HHD, less than 2 percent of patients perform HHD today. With such compelling information, why does Medicare continue payment policies that promote in-center dialysis?

We owe it to ESRD patients to do better, and fixing this problem is simple.

First, we need to adequately educate patients and the entire renal-care community about the benefits of more frequent home hemodialysis — to give every eligible patient the right to an informed choice.

Second, we must change the financial incentives so dialysis providers don’t lose money while they’re training patients who choose home hemodialysis.

Our hope is that through Hemodialysis at Home: A Better Way for a Better Life, we can work with patients, caregivers and other supporters to find their voices and tell Medicare that this is a problem that needs to be fixed right now.

With this in mind, supporters of this project will be reaching out to their members of Congress to talk about this issue and ask for their support. Some will travel to Washington this month — during National Kidney Month — with their dialysis machines in tow to meet face to face. After all, the Social Security Act specifies it is the intent of Congress that any patient who is a suitable candidate for home dialysis should be so treated. Unfortunately, that isn’t what is happening today.

Medicare’s long-standing policy of paying for more frequent, medically justified hemodialysis treatments supports keeping patients on HHD, but until this is coupled with adequate payment for upfront training, access to HHD will continue to be limited and the clear intent of Congress will not be fulfilled.

I hope we can count on our elected officials to do the right thing and tell Medicare that current policy must change to make HHD more accessible. Only then will ESRD patients truly have the opportunity to choose the therapy option that they — and their doctors — think is best for them.

Joe Turk is president of North America at NxStage Medical Inc.

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