Campaign Aims to Expand Home Dialysis

Full access

Several healthcare organizations have joined forces to launch Innovate Kidney Care, a campaign to improve patient options to receive home dialysis training and support. The organizations include Anthem, Inc.; Cricket Health; CVS Kidney Care; Home Dialyzors United; Intermountain Healthcare; the National Kidney Foundation; Outset Medical, Inc.; Strive Health; as well as ASN.

As part of its efforts, Innovate Kidney Care plans to advocate for the Centers for Medicare & Medicaid Services (CMS) to modernize its end-stage renal disease Conditions for Coverage and related guidance to achieve the quadruple aim of better patient outcomes, improved patient and provider experience, and lower costs of care. Among the group's goals are the following:

  • removing barriers to home dialysis training and support;

  • differentiating regulations to expand home dialysis training and support and improving transitions of care;

  • alleviating the clinical burden of administrative tasks to focus on patient outcomes, empowerment, and safety; and

  • allowing for home dialysis training and support to be delivered in a variety of healthcare settings.

With improvements in technology, as well as new service models aiming to create more convenient, flexible options for patients as to when, where, and how they receive dialysis, “We could be right at the cusp of a new dawn for home dialysis,” said Leslie Trigg, MBA, Chief Executive Officer of Outset Medical.

Some elements of CMS' regulations stem from a decade or so ago and “don't quite match” today's environment, Trigg said. “We were interested in joining because we believed in the power that some modernization of regulations could have in creating this tipping point for home dialysis.”

The Conditions for Coverage were designed for an era in which all patients would dialyze in a clinic, she said. “That's 1.0 dialysis. 2.0 dialysis is flexibility, convenience, and choice.”

One aim would be to allow service providers to more easily offer transitional care units designed to transition patients to home dialysis. Currently, providers offering this service must adhere to the same regulatory requirements of a conventional dialysis clinic even though their mission is different, Trigg said. There also is a lack of clarity in the regulations around who can help train patients to transition to home dialysis—a dialysis nurse or a technician or nurse practitioner working under the direction of a dialysis nurse. A better explanation of this could help, especially during the nation's current shortage of dialysis nurses, Trigg said.

Furthermore, nephrologists currently do not receive the same payments for supporting dialysis patients at home versus the clinic, Trigg said. “It seems pretty good common sense that their workload is certainly at least equivalent when supporting patients at home versus in-center. We feel that it's important for nephrologists to have pay equity between the center and home.”

The campaign's goals aligned for Inter-mountain Healthcare, which about 2 years ago developed a value-based kidney care program focused on early identification and management of individuals with chronic kidney disease, said Ray Morales, MPA, the health system's Assistant Vice President of Kidney Services. The company has a home-first policy for patients needing dialysis.

“This collaboration really fits well within our mission and the program we've built to look at empowering the patients with the right information at the right time,” Morales said. “It also modernizes existing policies and regulations to help support advancements in home dialysis therapies and allows for support around self-care dialysis.”

The campaign's work also fits for the National Kidney Foundation, said Miriam Godwin, the organization's Director of Health Policy.

“What patients want…is a system that's really designed around how people with kidney failure want to live, rather than having people try to fit their lives around dialysis,” she said. “It's a really exciting time in kidney care to try and do things differently, and we're really honored and pleased to be part of that innovation.”

The group plans to produce a white paper describing its position, Godwin said. For more information, see