A unique training program in Indianapolis may be the answer to getting more patients with end-stage renal disease to dialyze at home.
Dialysis treatment giant Fresenius Kidney Care launched its home dialysis training program as a pilot in January with four patients. In early February, the program was certified by the state of Indiana and can now accommodate up to eight patients at a time.
In traditional home dialysis training programs, nurses work one-on-one with patients to teach them how to use dialysis equipment, according to Fresenius Home Therapy Clinic Manager Wendy Taylor. This program allows nurses to train multiple patients at once in a Fresenius facility.
“When you just have one or two nurses, it may be weeks before a patient can be trained,” Taylor told McKnight’s Home Care Daily Pulse. “With this program, we can accommodate so many more patients and get them through so much more quickly and at home where they want to be.
The Centers for Medicare & Medicaid Services has been pushing providers to get more patients to dialyze at home. Patients with ESRD are among the most costly to Medicare. While they represent less than 2% of the Medicare beneficiary population, they account for approximately 9% of spending in traditional Medicare
That is why the Centers for Medicare & Medicaid Services launched the End-Stage Renal Disease Treatment Choices Model two years ago in an effort to move more dialysis into the home and reduce Medicare costs by a projected $23 million over five years. The program offers incentives to dialysis providers and nephrologists who encourage patients to dialyze at home, rather than in a clinic. A study last year by Baylor University College of Medicine found patients who dialyzed at home cost Medicare about 11% less than those who received treatment in facilities.
But moving the needle on home dialysis has been a slow process. The United States Renal Data System estimated about 13.3% of dialysis was performed at home in 2020. Fresenius and DaVita Kidney Care — the nation’s two largest providers of dialysis treatment — estimated in-home dialysis increased to roughly 15% last year.
Experts say a lack of broadband access to connect patients to clinicians, misaligned economic incentives to providers and inadequate training are a few of the obstacles that prevent patients from dialyzing at home. Taylor said this training addresses another barrier.
In-home dialysis can be isolating for many patients. She said learning in a group helps patients form bonds with other patients and possibly form support groups.
“When these patients come to the training facility and they see other patients dealing with similar situations, it really opens up their eyes that they are not alone and not the only ones going through this,” she said.
A spokesman for Fresenius told McKnight’s Home Care Daily Pulse the company evaluates each market for dialysis training and might replicate the Indianapolis training program in other cities if “the dynamics work.”
