KANSAS CITY, Mo. — Improving the transplant rate and ensuring patients are presented all options for kidney care are high priorities for Advancing American Kidney Health, an HHS official said during a keynote talk, here.
Nicholas Uehlecke, who is an advisor to HHS Secretary Alex Azar II and leads staff on the initiative, told attendees at the Annual Dialysis Conference the agency has been focused on development of new payment models that will encourage an integrated care approach to kidney care while also reducing the regulatory burdens the dialysis industry faces in treating patients.
“I’ve met 192 patients from 3 to 93 [years of age] and visited my first dialysis clinic in 2013. The program has a lot of catching up to do with the rest of the medical world,” Uehlecke, a former staffer with the House Ways and Means Committee, said.
Advancing American Kidney Health is aimed at raising awareness of the disease among the general public, helping to develop preventive measures for treatment and educating patients on modality options, Uehlecke said.
“When it comes to renal failure, I feel the communication is not really there. [Th]e number of people who are unaware of their disease is something we are working on. We have 80 million-plus Americans dealing with pre-diabetes and some 42% of people with kidney disease don’t know they have it.”
Part of the education process is aimed at primary care physicians, Uehlecke said, with performing more kidney transplants as “the number one goal ... [P]eople I know say an organ at 50% is better than no organ at all.”
When people arrive in the hospital for emergency dialysis, staff should with nephrologists and the outpatient kidney care team to come up with other options beside in-center dialysis and placement of a temporary catheter, he said.
“We want people in the hospitals to be prepared so that every time a kidney patient crashes, the number one option is not to get them into [in-center hemodialysis]. We want to make sure that patients have a choice,” Uehlecke said.
He also addressed concerns that the push by the Advancing American Kidney Health to move more patients to home dialysis may be limiting choice.
“In no way are we going to tell you that you have to [dialyze] at home if you prefer the dialysis facility,” Uehlecke said.
Part of the reason why patients end up in the dialysis center is because CMS provides more financial incentives to nephrologists and providers, he noted.
“The issue we have today is most folks [have] dialysis in center, and that is the result of our reimbursement structure,” Uehlecke said. “We pay less for patients who dialyze at home. We don’t pay for things like storage [of supplies] ... we need to pay for self-care in the center so patients can become comfortable with dialyzing at home.
“Choice is the number one objective that we want to push as part of this initiative,” Uehlecke said. “It is important that we move forward on these various aspects of the executive order.” – by Mark E. Neumann
Uehlecke, N. Special lecture from the Office of Alex Azar, Secretary of Health and Human Services - Advancing American Kidney Health Initiative to improve the lives of Americans with kidney disease. Presented at: The Annual Dialysis Conference; Feb. 8-11, 2020; Kansas City, Missouri.
Disclosure: Uehlecke reports no relevant financial disclosures.