“Fellowship programs need to be able to train their fellows, because if they don’t train their fellows, the future nephrologists aren’t going to know about home therapies," said Bukart. "There are different courses through fellowship that are available on home dialysis.”
Joyce Jackson, president of Alliance for Home Dialysis and CEO of Northwest Kidney Centers, made three important points about HHD during the conference. First, she said people are coming together to “congeal around the concept of home dialysis as a therapy that we need to advance for our patients in the United States, and the Alliance for Home Dialysis is evidence of that.”
“My second point is that there are many barriers of home dialysis but one of the teeny areas of barriers are regulatory and payment issues and those involve regulations and policy,” she said. “From the very beginning, there have been many barriers around payment of home dialysis.”
The costs of HHD is that it’s expensive and the $35 per treatment add-on for home training isn’t enough, she added
“We’re faced with barriers to fund more than three treatments a week for frequent home hemodialysis,” Jackson said.
Point number three is that you can make a difference and through the alliance people can come together and work towards that change, she added.
On March 29, a group of people got together to discuss home dialysis policy, barriers and what could be done about them. The steering committee consisted of two professional groups, American Society of Nephrology and Renal Physician Association. There were also two manufacturers, Baxter and NxStage; two patient organizations, Dialysis Patient Citizens and National Kidney Foundation; and two provider organizations, Northwest Kidney Centers and Satellite Healthcare. Affymax and DaVita also joined in to help pull everything together.
The team came up with three barriers: accessibility, accountability and incentives.
There are four task forces in this group that are constantly working on what can be done to address barriers, Jackson said.
“Wouldn’t it be great if we could expand the Medicare CKD benefit so that Medicare would pay for CKD education for people who are in stage 3 or 4?” Jackson asked. “Could we develop better physician training to help nephrologists be prepared to care for patients on home dialysis.”
Those are some things that the task force discussed.
The accountability workforce focuses on conditions of coverage by making sure that home dialysis is supported as much as possible.
“Quality measures are looked at,” she said. “How much of the QIP [quality improvement program] exempts home dialysis patients?”
The payment should be raised to more than $35 per treatment as well as more frequent hemodialysis should be taken into consideration, Jackson said
Because the alliance is so new, organizations are encouraged to join to discuss what can be done to advance home dialysis, she added.