Health Care

1 out of 7 Adults Have Kidney Disease. New Rules Will Make Treatment Better and Easier

(saengsuriya13/iStock/Getty Images Plus)
The pandemic has forced new thinking into medicine — and it’s about time.

The virus pandemic has put American medicine to the test like few other events in our history.

As horrible as its toll has been, COVID-19 has also unleashed medical trends that will have the long-term effect of improving medical outcomes in other areas.

Deloitte Consulting’s new survey of U.S. health consumers finds that telemedicine, which has seen rules discouraging it dropped, has soared in popularity. Consumers using virtual visits jumped from 15 percent last year to 28 percent this April. The number is no doubt higher now.

“Consumers are increasingly willing to tell their doctors when they disagree with them, are using tools to get information on costs and health issues, are tracking their health conditions and using that data to make decisions, and accessing and using their medical record data,” reports Deloitte.

Another medical advance came in July, when the Trump administration issued an executive order modernizing the government’s fight against kidney disease.

An astonishing 15 percent of adults (37 million Americans) have kidney disease, and more than 120,000 start dialysis treatments to filter and replenish their blood every year. Kidney disease is the ninth-leading cause of death in the U.S., and taxpayers spend over $110 billion a year fighting it. Medicare funds kidney dialysis for all those who need it regardless of age. The money it spends is more than the budgets of the National Institutes of Health, the Department of Homeland Security, and NASA combined.

The Trump administration’s new order makes changes on several fronts. More kidneys will be made available for transplant and innovative treatments encouraged. But the thrust of the new approach will be to reverse the 50-year-old trend toward having dialysis patients go to a treatment center.

In 1973, 40 percent of dialysis patients had their treatments at home.

But then Medicare changed its incentive structure toward institutionalized treatment. Until recently, all machines built for dialysis treatments were large and believed to be too expensive to be used at home. As the number of people being treated in centers grew, the number of centers that offered home care shrank. By early this year, some 90 percent of patients were going to a dialysis center for their treatment.

One reason is that two large dialysis organizations have a hold on providing the service, cornering about 80 percent of the market. The industry lags in making improvements in innovation, cost, and flexibility. In 2019, a typical dialysis patient cost Medicare about $89,000 a year. Home dialysis is far less expensive and is far more often used in other industrialized countries. The government’s new policy will provide incentives for early diagnosis, better patient education, and holistic care services.

But the onslaught of COVID-19 has forced a rethink. People with kidney disease often require care up to three times a week and in person, sitting next to others. During a pandemic, requiring that kind of care can be life-threatening. Patients with kidney disease who have COVID-19 have among the highest rates of hospitalization. Patients spend many hours several times a week at dialysis centers, a grueling process that reduces the quality of both their lives and those of their caregivers.

So a key focus of the executive order is to encourage in-home dialysis. Because many patients find they suddenly need dialysis and often aren’t eager to be educated about home dialysis, they have been pushed toward treatment at centers instead. But home dialysis can be a safe treatment option that produces better health outcomes, doesn’t expose patients, and often costs less.

Starting next year, dialysis patients will be able to enroll in Medicare Advantage plans that provide better access to treatments that can be provided at home.

Many medical professionals believe the new approach will improve patient care. Rene, a dialysis nurse with Fresenius Kidney Care in Naples, Fla., told The American Spectator: “With 25 years of dialysis care experience, one of the most difficult things I’ve seen for our patients is loss of freedom because they can’t always have treatments on their time. An important priority for us is educating patients about their disease and treatment options even before they require dialysis, and I think most of them would choose in-home treatment.”

Kerri Toloczko, a senior policy fellow with the Institute for Liberty, says new medical-treatment thinking brought about by the challenges of the coronavirus are a long-overdue effort to shake up the system: “In the private sector, businesses ask customers what they want, and then provide it. In the government sector, bureaucrats decide what people want and demand they accept it. With these changes, putting patients’ needs ahead of bureaucratic system convenience could — and should — become baseline.”


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