Time to Focus on Increasing Organs for Patients With ESRD, Azar Says at Kidney Week

Allison Inserro

HHS is taking additional steps to improve care for those with end-stage renal disease (ESRD), Secretary Alex Azar announced Thursday. Speaking at a tightly packed session during the American Society of Nephrology (ASN)’s Kidney Week 2019, Azar said HHS is looking to speed organ transplants to those who need them as part of an overall shift away from dialysis in kidney care centers and as part of its overall desire to lower spending while improving outcomes.

“Today, we have a system that pays for dialysis, rather than transplants—so what we get is lots of dialysis, and not as many transplants as we should have,” he said. “It’s time for that to change.”

Last week, HHS finalized 3 ESRD payment rules—those for Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS), the ESRD Prospective Payment System (PPS), and the ESRD Quality Incentive Program (QIP)—with an eye to support new technology; combat waste, fraud, and abuse; and offer better access to new treatments.

In addition, Azar said Thursday, the Health Resources and Services Administration will issue a request for information (RFI) shortly looking for ways in which technology can be used to allocate organs and handle patient and donor data.

HHS has already formed a public-private partnership with ASN on KidneyX, which seeks to accelerate development of breakthrough technologies not only for treatment but also prevention. Through a new RFI, KidneyX wants to move these advances to human trials; Azar said the RFI includes information on ”regulatory, coverage, and payment options for a wearable or implantable artificial kidney, including the availability of Fast Track programs at FDA.”

In addition, NIH is looking for applications to its small-business innovation research program for the development of new technologies for an artificial kidney. He also noted that, last week, the FDA awarded a contract to the Kidney Health Initiative for a 3-year project that will measure patient preferences and risk tolerance for novel treatments for kidney failure.

Through various initiatives, HHS said it seeks to reduce ESRD in Americans by 25% by 2030; reduce the number of patients receiving dialysis in a center by 80% by 2025; and double the number of kidneys available for transplant by 2030.

It is also seeking to promote value-based care with new payment models. One involves 4 optional payment models, known as Kidney Care Choices. Another is a proposed mandatory model, known as ESRD Treatment Choices, to encourage providers to shift patients to receiving home dialysis.

ASN's Kidney Week is taking place November 5-10, 2019, in Washington, DC.

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