By Joe Turk and Linda Upchurch
Although nine out of 10 physicians and nurses would choose a home modality for themselves and family members, Medicare payment policy remains a significant barrier to patient access to home hemodialysis
(HHD). Given Centers for Medicare & Medicaid Services (CMS) commitment to quality and improved care, it is shocking and perplexing that CMS did not take steps to rectify this in its current proposed rules.
CMS needs to remove the barriers to HHD access, specifically by fixing payment for up-front training, as it refines its rules for 2013 implementation.
We all recognize the opportunity for major improvement in the care of patients with kidney failure. Very telling was the opening to a key section of the 2011 Annual Report of the United States Renal Data System (USRDS):
“Thrice-weekly treatment may be inadequate for addressing the critical problems of persistent fluid overload, hypertension, left ventricular hypertrophy, and recurrent vascular access infections and complications.”
The momentum continues to build in support of more frequent hemodialysis at home as the therapy option that may address many of the seemingly intractable problems facing our dialysis population. The data show substantial clinical benefits for patients, including: reduced recovery time, better sleep, higher quality-of-life, reduced depression, better cardiovascular health and improved survival. Recent data also show a higher rate of transplantation, a wonderful outcome for patients.
Private payors are taking the lead in clarifying coverage and payment to ensure that home and more frequent hemodialysis therapy are recognized and are more readily accessible to their beneficiaries.