May 08, 2018
2 min read

American Society of Transplantation: PATIENTS Act would limit access to transplantation

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The American Society of Transplantation opposes the Dialysis Patient Access to Integrated-care, Empowerment, Nephrologists and Treatment Services Demonstration Act, also known as the PATIENTS Demonstration Act, saying it would limit patient access to transplantation. The group joins dialysis provider Dialysis Clinic Inc., the American Association of Kidney Patients and the Kidney Care Alliance, which note the act would limit patient choice and favors the country’s two largest for-profit dialysis organizations.

In comments released April 17, the American Society of Transplantation (AST) board of directors said the intent of the act is “laudable.”

“As introduced, H.R. 4143 and S. 2065, the Dialysis PATIENTS Demonstration Act seeks to promote innovation, efficiency and the improvement of the quality of care for patients receiving kidney dialysis. Stakeholders in support of the legislation have stated that they believe patient care will be improved through the fostering of greater integrative and coordinated care for the end-stage renal disease (ESRD) population,” the AST board wrote.

However, the AST wrote that the legislation would significantly compromise patient access and referral to organ transplantation by restricting the freedom of patients to choose their dialysis provider — some who may not be advocates of transplantation.

“The ability to choose providers serves as an incentive for innovation and improvement in the quality of care delivered regionally. This patient choice must be preserved ... and not relinquished to for-profit entities focused largely and primarily on the business of administering dialysis,” the AST wrote. “Do patients, physicians and the nephrology community wish to entrust the identification, referral and approval/access for kidney transplantation to for-profit dialysis organizations? How do these organizations disentangle themselves from the strong financial incentives (contained in S. 2065 & H.R. 4143) not to transplant?”

The act would allow dialysis organizations to bear full risk for the care of the ESRD population, the AST wrote.

“For the first time, it will allow dialysis providers to acquire or create insurance companies with little or no effort, allowing them to be the at-risk entity (Medicare Advantage Plans). Given the substantial capital and regulatory requirements required to assume risk, the Dialysis PATIENTS Demonstration Act will likely create an exclusive policy landscape and opportunity for the two large dialysis organizations: Fresenius Medical Care and DaVita Health.”

On its website, Fresenius said in supporting the legislation that it would “utilize the dialysis facility as a central command point for patients to access coordinated health care services. This practical approach to care delivery would significantly improve health outcomes and increase quality of life for ESRD patients while reducing costs to the system through reduced hospitalizations and readmissions.”


Dialysis Clinic Inc. noted that the legislation “doesn’t improve patient care, rather it creates a new payment method that would only benefit the largest providers in the industry.

“An innovative, integrated kidney model should include [chronic kidney disease] CKD care, palliative care, transplantation, medical management and hospice. Unfortunately, the Dialysis PATIENTS Demonstration Act covers none of those critical services and requires a patient to leave the organization if that care is needed. Creating silos of care is not integrated care and is not in the best interest of the patient.”

“Alternative payment models (hospital ACOs) are the future of medicine, including the care of ESRD patients,” The AST wrote. “These models are based on caring for a population, cradle to grave. However, as currently introduced, S. 2065 & H.R. 4143, the Dialysis PATIENTS Demonstration Act relinquishes this care to for-profit private sector companies.”


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