Healio Special Report: Health Care and Politics

Healio Special Report: Health Care and Politics

July 10, 2019
2 min read

Trump executive order pushes for 80% of ESKD patients to have transplant or be on home dialysis by 2025

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Donald J. Trump

President Donald Trump signed an Executive Order today to launch Advancing American Kidney Health, a new initiative to increase earlier intervention in CKD, incentivize dialysis providers to direct more patients to home dialysis and increase the number of kidneys available for transplantation.

Specifically, HHS announced goals to improve kidney health that include:

  • reducing the number of Americans developing end-stage renal disease by 25% by 2030;
  • having 80% of new ESKD patients in 2025 either receiving dialysis at home or receiving a transplant; and
  • doubling the number of kidneys available for transplant by 2030.

The plan includes five new treatment models, released by CMS through its Center for Medicare and Medicaid Innovation and to be implemented next year, that will eventually include over 200,000 patients in demonstration projects to test whether the payment changes improve outcomes.

“President Trump is tackling the toughest issues in American health care, and few areas need reform more than the way we treat kidney disease,” Alex Azar II, HHS Secretary said. “Decades of paying for sickness and procedures in kidney care, rather than paying for health and outcomes, has produced less-than-satisfactory outcomes at tremendous cost. Through new payment models and many other actions under this initiative, the Trump Administration will transform this situation and deliver Americans better kidney health, more kidney treatment options and more transplants.”

HHS said approximately 20% of dollars in traditional Medicare — $114 billion a year — are spent on treating kidney disease in the U.S.

The President’s Executive Order also calls for HHS to:

  • launch a public awareness campaign to increase knowledge of chronic kidney disease;
  • reform the organ procurement and management system in the United States to significantly increase the supply of transplantable kidneys;
  • expand support for living donors through compensation for costs such as lost wages and child care expenses; and
  • encourage development of wearable or implantable artificial kidneys, through cooperation between developers and the Food and Drug Administration (FDA) and support for KidneyX, a public-private partnership between HHS and the American Society of Nephrology.

Azar said part of the initiative includes working further toward reducing disparities in performance among organ procurement organizations (OPOs) and transplant centers with the goal of increasing recovery of kidneys by OPOs and use of kidneys by transplant centers.

Trump said in announcing the new initiatives that the changes in how kidney disease is treated would save $4.2 billion a year, saying that increasing the number of patients who dialyze at home – now around 12% – is “a dramatic overdue reform.” – by Mark E. Neumann

Reference: Trump D. Remarks by President Trump at Signing of Executive Order on Advancing American Kidney Health. July 10, 2019. Transcript available at: https://www.whitehouse.gov/briefings-statements/remarks-president-trump-signing-executive-order-advancing-american-kidney-health/.