Highlighting successful strategies to increase patient access to home dialysis and reduce racial disparities in home modalities, ASN Councilor Susan Quaggin, MD, FASN, of Northwestern University in Chicago, addressed a packed briefing room on Capitol Hill in May 2016.
The US has one of the lowest utilization rates of home dialysis in the world, with just around 10% of patients dialyzing at home via peritoneal dialysis (PD) or home hemodialysis (HHD). Furthermore, there are significant disparities in home dialysis: African-Americans and other minority populations are considerably less likely to use a home modality compared to Caucasians.
The congressional briefing, “Alliance for Home Dialysis Hill Briefing: Improving Access through Policy Innovation,” addressed the equitability of home dialysis, care partner requirements for home patients, telehealth, and kidney disease education. The briefing was convened by the Alliance for Home Dialysis, a Washington, DC-based coalition—of which ASN is a member—dedicated to advancing policies that support appropriate utilization of home dialysis.
Quaggin and other speakers called attention to policy changes that may eliminate barriers to home dialysis for some patients. Having recently moved to the US from Canada—where “home first” is the standard approach in many dialysis clinics—she shared an international perspective and illustrated, through her more recent efforts at Northwestern University, that significant advances in home dialysis utilization are achievable. But in addition to demonstrating the potential to grow home dialysis, Quaggin also called for congressional support for several key policy changes supported by ASN, the Alliance for Home Dialysis, and other stakeholders in the kidney community.
Designating a patient’s home as an “originating site” under Medicare would allow home dialysis patients to interact with their nephrologist via telehealth technology (such as videoconferencing on an iPad) from home instead of going into an office. The bipartisan Medicare Telehealth Parity Act of 2015 proposes giving patients this option, and the Senate Finance Committee has also considered including designating the patient’s home as an originating site in its forthcoming Chronic Care bill. Also under consideration is a proposal that would designate the dialysis facility as an originating site (meaning patients can interact with their doctor via telehealth technology from the dialysis facility when the doctor is offsite). This policy change is currently proposed in the bipartisan, bicameral CONNECT Act. ASN and the Alliance for Home Dialysis support both policy changes.
Ensuring more people get access to education about their dialysis treatment options is crucial to increasing appropriate home dialysis use. Larry Weisberg, MD, nephrology division chief at Cooper University Hospital near Philadelphia, presented compelling data demonstrating that patients who receive education about home dialysis choose it over in-center dialysis significantly more often than patients who do not.
In 2008, Congress enacted the Medicare Kidney Disease Education Benefit, which was designed to help people learn about options and manage their disease before starting dialysis. But the Government Accountability Office recently reported that fewer than 2% of eligible beneficiaries have utilized this benefit, in part because only a few types of providers can offer it. ASN and the Alliance are urging Congress to identify mechanisms to enable more patients to access this benefit.
Building support on Capitol Hill for these and other policy changes that would support home dialysis remain a top advocacy priority for ASN and the Alliance for Home Dialysis. Continuing engagement with congressional champions on the Senate Finance Committee, securing more bipartisan co-sponsors for the CONNECT Act and the Medicare Telehealth Parity Act of 2015, and raising awareness about home dialysis among policymakers are among the activities still in store for the final months of the 114th Congress.
