The president’s recent executive order, “Advancing American Kidney Health,” will stimulate change while keeping patients at the center of care without getting bogged down in the process of doing so.
The end goal is clear: to improve care for kidney patients and move the U.S. one step closer to a more efficient and coordinated healthcare system. It’s something the kidney care industry has advocated for more than a decade.
The best way to accomplish this is in partnership with the government. We need to collaborate to develop value-based care arrangements where physicians and other healthcare providers can deliver integrated care to patients in all stages of kidney disease. Current reimbursement models from the government fall short. They suffer from funding shortages and timing delays. The economic uncertainty created by these flaws stifles meaningful investment, which limits progress and innovation. Patients deserve better.
Our community needs a reimbursement system that incentivizes change and attracts the capital investment necessary to transform care. Such a change can only be made when we join forces—as a society, as a healthcare system and as a kidney care community.
The executive order issued this past July pledges to reduce kidney failure by 25% over the next decade and to double the number of transplants, which DaVita knows and supports as the best treatment option for eligible patients. It also aims to increase at-home dialysis treatments.
It could herald a full shift to value-based care for kidney patients—a model that has become a difficult to obtain ideal across healthcare. Under value-based care arrangements, physicians and providers are compensated if they keep patients healthier, with the idea that better outcomes and healthier patients create savings for the healthcare system. In our industry, it gives providers the additional resources needed to coordinate care and address our patients’ kidney and non-kidney care needs, such as diabetes, high blood pressure or related mental health issues. It also holds promise to advance work on prevention of kidney disease and kidney failure rather than just treatment after the fact.
This is important for all Americans, not just those directly impacted by kidney disease. If left untreated, kidney disease can become kidney failure. In 2016, kidney disease accounted for about one-fifth of all Medicare spending. The average dialysis patient receives about 144 treatments each year. While efficiencies that dialysis providers achieved in delivering care have helped contain costs, if we can lower those costs through collaboration and coordination, we will significantly reduce overall spending in healthcare, all while improving and saving lives.
This is not a new idea; it’s the change nephrologists and other providers have spent years advocating for because we know—and have the outcomes to show—that the care our patients need does not fit in a fee-for-service world. DaVita has delivered integrated kidney care alongside our nephrologists in small- and medium-scale programs with the government and commercial payers for more than a decade.
However, to achieve the goals of the executive order and give all kidney patients the care they deserve, the federal government needs to realign its reimbursement system. Kidney care needs a system that allows physicians and providers to make the investments required to change how care is delivered and redesign how providers along the care journey work together.
Overcoming such barriers benefits the entire health system. When providers can confidently invest in care transformation, patients benefit from having their needs better met and it reduces costs to taxpayers.
The greatest single strength of the executive order is that it is patient-centered. The government clearly understands that it must better address the complex needs of our patients. This is an important step. Coming together to realign the reimbursement model to truly transform the system should be the next one.
