Opinion

Congress Has the Opportunity to Greenlight Proven Care Models for Chronically Ill Patients, Starting with Kidney Patients

Each day, millions of Americans are forced to confront an unrelenting, and in many ways, unassailable opponent.  This adversary comes in the form of so-called “chronic conditions” – illnesses, which can be managed but never cured. And despite immense progress in the way our nation combats disease, these widespread health burdens are currently responsible for 70 percent of all deaths in the U.S.

For 26 million Americans living with chronic kidney disease, or CKD, and 636,000 of those whose disease has progressed to kidney failure (called end-stage renal disease or ESRD), this battle with disease is a stark, and sometimes discouraging, reality.  Most ESRD patients are living with multiple comorbidities such as diabetes and hypertension. They often take more than eight different medications for varying chronic conditions and are hospitalized at least twice each year.  And they must depend on transplantation or weekly life-sustaining dialysis treatments to survive.

Clearly, patients’ diagnosed chronic conditions deserve extraordinary effort from those of us in the healthcare space. And for years, we at Kidney Care Partners – the leading coalition of nephrologists, nurses, dialysis providers, patient advocates, and manufacturers – have worked to elevate quality-of-care and enhance quality-of-life for CKD and ESRD patients.

But we recognize there is much more to be done – not only for kidney patients, but those suffering from chronic conditions such as Alzheimer’s and heart disease.  Thus, we applaud recent efforts of the Senate Finance Committee in establishing a working group to improve care for Medicare beneficiaries with chronic conditions.   There is a clear opportunity for Congress to act now to allow a number of care models available to patients, which is not only good for the patient, but the taxpayers  who fund these vital programs.

As lawmakers now contemplate ways to address our nation’s response to chronic illness, it is imperative that they reflect upon the voice of the kidney community and, more importantly, address the needs of kidney patients – a population expected to double over the next decade. Fortunately, this is achievable through simple systematic reforms with truly limitless potential.

First, it is critical to consider how those with CKD and ESRD are treated. Kidney patients with checkered health records must depend on numerous physicians.  In the past, this often meant countless appointments, repetitive tests, and suboptimal results.  But today, coordinated care – which facilitates collaboration amongst specialists and, therefore, highly efficient treatment paths – has fundamentally altered the way caretakers combat kidney disease.  Indeed, patients in coordinated care systems have experienced better health outcomes and fewer hospital admissions – cutting system-wide costs.

Unexplainably, however, current U.S. law prohibits Medicare beneficiaries who develop ESRD from enrolling in Medicare Advantage plans, which feature more structured coordinated care than the traditional fee-for-service program.  Put simply, regulations effectively bar those who could benefit most from highly effective care coordination – ESRD patients with myriad comorbidities. This unreasonable and highly inefficient exclusion must be overturned.

A truly effective transition to care coordination for kidney failure patients must also address incentives. Therefore, we believe it would be prudent to establish a voluntary care coordination program for ESRD that engages all parties in the kidney care process and rewards them for reducing non-dialysis Medicare costs.

Such a model would prove especially effective because it relies upon providers – those who interact with patients each day and those who know what works and what doesn’t – to innovate on a small scale.  However, in this case small-scale change could produce vast results coming in the form of improved health outcomes and reduced costs for both government insurers and American taxpayers.  Patients lean on their care providers and it’s time for our nation to do the same.

Finally, good policy should emphasize consistency.  Because of the incredible diversity of the ESRD patient population, it makes great sense to offer personalized health plans.  Interestingly, such a mechanism already exists in the form of Special Needs Plans.  SNPs have shown to be amazingly successful for ESRD patients.  Yet they continue to face the uncertainty of annual reauthorization.  Permanent reauthorization of SNPs, however, would ensure stability and protect patient access while allowing continued innovation in the treatment of ESRD.

Ultimately, improving care for Medicare beneficiaries with chronic conditions will be no easy task.  When it comes to kidney care, lawmakers have introduced a bicameral bill, the Chronic Kidney Disease Improvement in Research and Treatment Act (S. 598), which includes these provisions to elevate quality-of-care and enhance quality-of-life.  And the Senate Finance working group marks a fundamental next step towards progress.  In the end, though, lawmakers owe all patients with chronic conditions timely action for they cannot afford to wait.

Dr. Edward R. Jones is the Chairman of Kidney Care Partners, a broad-based coalition of patient advocates, clinicians, care professionals, dialysis providers, researchers and manufacturers working together to improve quality of care for individuals with chronic kidney disease (CKD) and ESRD. Dr. Jones currently serves as Chief of the Renal Section at Chestnut Hill Hospital in Philadelphia and Clinical Professor of Medicine at Temple University Hospital.