Exactly as I feared.
As I stated on 15 July 2019, when I discussed Trump’s Executive Order regarding dialysis, I considered that this executive order looked to be more aspirational than executional. Not even the End Stage Renal Disease Treatment Choices (ETC) payment model seems to have made a dent in the increased adoption of home dialysis services.
This ETC program is different from previous payment test programs that HCFA (Health Care Financing Agency, a unit of Medicare) has developed. This one is not optional; 30% of all facilities must participate- the other 70% serve as control sites.
Therefore, at the end of a year, it an be used for analysis. In particular, if the test facility has “good” home dialysis and transplant rates when compared to the controls, that facility gets a payment boost. If the facility fares worse, then its payments get decreased.
This ETC program runs through 2026, at which time, Medicare can elect to continue this for everyone- or terminate it.
It was thought that ETC would advance home dialysis as an augmented method of choice. After all, home dialysis treatments rose from 11.9% to 12.5% by the end of 2018 and 13.4% by the close of CY 2019. And, neither of those increases relied on the increased payment models. (And, just so you know, home dialysis is more likely to occur in other countries like the UK (17%), Australia (25%) and Canada (26%).)
Now, the question is whether the COVID-19 pandemic put the kibosh on further adoption of home dialysis. After all, deaths on home dialysis due to COVID reduced the census of patients be so treated- and even more patients died in center. Moreover, fewer folks initiated dialysis, which could have meant that the number of folks making the initial choice of home dialysis were greatly reduced.
The greater deaths for in-center dialysis (compared to home dialysis patients) probably explains why the percentage of folks on home dialysis rose to 14.5% by October 2020. And, both Davita and Fresenius (the two largest dialysis providers) report that 15% of their patients are being treated at home. But, these numbers mean we will only reach a home dialysis census of 17% by 2025. Not what the patients- or the directive- needs.
It means that we also need more folks sponsoring dialysis patients for Medicare Advantage insurance plans. That would mean that CMMS (Center for Medicare and Medicaid Services) has stopped blocking folks from sponsoring patients (paying their premiums) for such insurance. That along with the higher ETC payments should help promote home dialysis usage dramatically.
We need to get these patients treated at home. It’s not only easier, but better, for the patients.
How great would that be for the patients to be able to be treated at home!
Both for the convenience and for the total time involved in the treatment. I’m with you, Martha.