In an effort to shift more treatment of chronic kidney disease into the home and ensure patients have greater access to coordinated care, federal policymakers have proposed a series of new payment models for certain kidney-related conditions.

Officials from the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) unveiled the new payment models Wednesday, advancing goals set forth by a Trump administration executive order.

While they do not target home health providers specifically, industry insiders and kidney treatment experts say the newly proposed payment models may lead to emerging opportunities down the road. Currently, home health providers do not widely offer dialysis or other specialized kidney treatment, in part because of reimbursement barriers and a lack of overall financial incentives.

“Many patients can receive home dialysis but don’t today, and the policies announced [Wednesday] will enable patients to spend more time at home instead of being in a dialysis center three times per week,” Dr. Michael Cantor, chief medical officer at CareCentrix, told Home Health Care News.

Hartford, Connecticut-based CareCentrix is a home health provider that has a national network of over 8,000 locations. The company views in-home dialysis as an area of opportunity and is looking at innovative ways to make in-home dialysis a reality. 

“The new executive order should provide the financial model needed to accelerate the innovations we have been considering and accelerate adoption of home dialysis,” Cantor said.

Under the proposed model, the CMS will adjust payment to ESRD facilities and managing clinicians for home dialysis and dialysis-related services during the first three years. 

Overall, the goal of the model is to give ESRD beneficiaries more flexibility in their choice of treatment.

“Whenever possible we should bring the care to the patient rather than bringing the patient to the care, and kidney dialysis is a great example of a service that should be provided at home whenever possible,” Cantor said. 

About 700,000 people in the U.S. have chronic kidney disease, and about a half-million of them are currently undergoing dialysis, according to the United States Renal Data system

Generally, kidney care patients on dialysis make monthly visits to their nephrologist. On the in-home end, dialysis is usually delivered by companies who have developed home-based programs. 

Today, 12% of the roughly 600,000 Americans who need dialysis receive treatment at home, according to Bobby Sepucha, chief administrative officer for Cricket Health.

“Unfortunately, the incentives that were put in place decades ago by our healthcare system push patients out of their homes and into dialysis centers,” Sepucha told HHCN. “This is exactly backward. Instead of favoring in-center care over home therapies and transplants, we should do the reverse. We should make in-center dialysis the last resort treatment.” 

Cricket Health is a San Francisco, California-based provider of integrated nephrology and dialysis care, which they provide in the home and institutionally. 

But with the new proposed payment model, many home health providers are optimistic about the potential opportunities for in-home dialysis.

“Home dialysis seems like an opportunity for home health providers to partner with dialysis providers to offer comprehensive services for patients on home dialysis,” Cantor said. “Given the many medical co-morbidities of dialysis patients and the large number with functional impairment, creating a comprehensive home health program for dialysis patients that enables them to stay home for dialysis treatment as well as other home services is a very attractive model.” 

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