- The Washington Times - Wednesday, July 10, 2019

President Trump ordered a shakeup of the kidney care market Wednesday, saying the current way of doing things is too expensive for taxpayers, vexing for patients, and costing lives.

He issued an executive order he said will streamline the process for matching patients with donated kidneys, and will create incentives for doctors to intervene early on warning signs such as diabetes or high blood pressure, saying it will avert costlier later treatments like dialysis.

He hopes that will cut the high costs in Medicare, where officials said the program spends more than $110 billion a year on kidney care — an amount that exceeds federal spending on the National Institutes of Health, NASA and the Homeland Security Department combined.

Surrounded by patients, Mr. Trump said the kidney effort is the latest in his string of campaigns to eradicate health crises with deep roots, from the heroin and prescription painkiller epidemic to childhood cancer and HIV/AIDS.

“So many things don’t get done in government, but now we’re getting them done,” Mr. Trump said to applause at the Ronald Reagan Building and International Trade Center.

All told, Mr. Trump wants to double the number of available kidneys by 2030, while slashing end-stage renal disease by 25%.

Kidney disease affects a whopping 30 million Americans and is the ninth-leading cause of death, yet officials said federal payment models for dealing with it haven’t really changed since President Richard Nixon signed the Medicare kidney-disease entitlement into law in 1972.

“For 50 years, we have basically had a stagnant system of how we treat people who have chronic kidney disease,” said Health and Human Services Secretary Alex M. Azar II.

Mr. Trump’s order will crack down on nonprofits that are responsible for the procurement of organs for transplants in each region of the U.S., yet are too slow to identity transplant recipients. And it provides new federal support for kidney donors who lose wages or confront child care costs after going under the knife.

The National Kidney Foundation welcomed the changes, saying the sector needed reforms.

“The administration’s commitment to charting a new course for kidney health will help revolutionize transplantation and dialysis and advance new innovations, therapies and treatments which patients everywhere have been waiting on for far too long,” CEO Kevin Longino said. “Kidney care is, for the first time in decades, experiencing a renaissance that can transform the lives of millions of Americans while also saving taxpayers billions of dollars.”

In some ways, the issue is personal — Mr. Azar’s father needed dialysis and a transplant, and first lady Melania Trump was treated for a “benign” kidney condition last year, though the president didn’t mention that in his speech.

Administration officials said the president decided to tackle this specific part of health care because he loves to take on “stubborn” problems that have bedeviled past presidents.

“This fits neatly in the wheelhouse of the type of problems that the president likes to confront,” said Joe Grogan, director of the White House’s Domestic Policy Council. “This has been ignored through Republican and Democrat administrations. Our current quality outcomes are pretty pathetic in this area, and it’s something the president understood needs to be addressed.”

The administration said it plans to launch an awareness campaign on how to prevent kidney disease and become a donor, as more than 100,000 Americans await transplants.

About 10 patients die each day while waiting, while others face onerous trips to dialysis clinic multiple times per week.

Only 12% of patients receive dialysis in their homes, officials said. Mr. Trump wants to increase the share of those either receiving home treatment or obtaining a transplant to 80% by 2025.

DaVita, a company that serves over 200,000 kidney patients and owns many brick-and-mortar clinics, said it welcomes the disruption, pointing to its investments in technology that makes it easier to monitor patients remotely.

“We are best positioned to deliver in the home dialysis space, as the largest provider of home dialysis in the U.S.,” CEO Javier Rodriguez said.

Another leading company, Fresenius, said it’s merger with NxStage, which makes a hemodialysis machine for home use, will help it meet Mr. Trump’s goals.

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