hemodialysis in people on the equipment

Costs to patients, physicians and dialysis facilities are barriers to home dialysis, according to a team of researchers at Baylor College of Medicine.

In a recent study, the team said misaligned economic incentives, underappreciated costs for stakeholders involved in the delivery of peritoneal dialysis care, variation in costs across dialysis providers, and upfront costs incurred when switching to peritoneal dialysis must be overcome before home dialysis can replace facility-based care.

The researchers said comparing the costs of peritoneal dialysis and hemodialysis has typically focused on the perspective of the payer, not on the perspective of patients and providers. They suggest improving data collection to better understand the costs of peritoneal dialysis and sharing savings among all stakeholders would incentivize a transition to home-based care.

In 2019, former President Donald Trump signed the Advancing American Kidney Health initiative. The executive order aimed to move more dialysis into the home and last year led to the launch of the End Stage Renal Treatment model, which requires 30% of treatment providers in all 50 states to encourage home dialysis or transplants. The goal is to save Medicare $23 million over five years. 

Home dialysis has been hamstrung by myriad issues, including access to broadband service, logistical barriers and in-home training. Last week, an advocacy group, which includes health plans, equipment companies and the National Kidney Foundation, urged the Centers for Medicare & Medicaid Services to allow equipment manufacturers to train patients on how to dialyze in their homes. 

Last fall, a bipartisan team of lawmakers introduced the Improving Access to Home Dialysis Act, which would provide Medicare reimbursement for trained medical staff to help patients with their home treatments.