Trump to order overhaul of organ transplant, kidney dialysis systems
By LENNY BERNSTEIN AND KIMBERLY KINDY | The Washington Post | Published: July 9, 2019
President Donald Trump will order a broad overhaul of the nation’s organ transplant and kidney dialysis systems Wednesday in an executive order designed to prolong lives and save the government billions of dollars, according to people familiar with the plan.
Trump will outline proposals to keep people with kidney disease off dialysis longer and to make treatment less expensive, to encourage more live donation of kidneys and livers, and to force the 58 nonprofits that collect transplant organs to improve their performance, people briefed on the plan said. He also will try to reduce the discarding of less-than-perfect organs by transplant surgeons.
In all, the government believes it can make 17,000 more kidneys and 11,000 more hearts, livers, lungs and other organs available for transplant every year, as well as save money for Medicare and Medicaid, which cover much of the cost of dialysis and transplantation. The U.S. has a severe shortage of tranplant organs. More than 113,000 people are waiting for them; most need kidneys.
“These are all good ideas. I’m impressed, very impressed,” said Tommy Thompson, who worked to boost organ donation when he was secretary of Health and Human Services under President George W. Bush. “They are finally modernizing organ procurement.”
The executive order the president is expected to unveil Wednesday, first reported by Politico, is one of a series of health care initiatives Trump is announcing in the run-up to the 2020 presidential election.
Kidney dialysis is a grueling regimen endured by about 510,000 of the 726,000 people who suffer from end stage kidney disease, according to the National Kidney Foundation. In the U.S., most people receive hemodialysis, a treatment that requires a device to filter waste and toxins from their blood. Most receive it in clinics or private facilities that serve dozens of people each day.
Average life expectancy for a person on dialysis is five to 10 years, though some live much longer.
A less expensive option is peritoneal dialysis, a treatment that uses a fluid infused through a catheter implanted in the abdomen, often while the patient sleeps. The process is used only by a small percentage of U.S. kidney patients.
Trump will order Secretary of Health and Human Services Alex Azar to test payment models that encourage doctors to treat kidney patients earlier in an effort to delay or prevent kidney failure. That would cut the rate of hospitalizations and dialysis and would encourage home dialysis.
Currently, the U.S. system creates incentives for clinic-based hemodialysis. Two companies, Fresenius Medical Care and DaVita, dominate the lucrative market. Physicians generally are reimbursed at higher rates for care of dialysis patients than for treatment of patients with kidney disease who don’t yet need dialysis. And Americans are not accustomed to taking care of themselves at home, something health care providers often discourage.
Chris Meekins, a research analyst at Raymond James, said a shift toward home dialysis would hit both companies, but would hurt DaVita more because the company has not made as large an investment in that field.
Meekins said he didn’t expect to see new rules begin to have an impact for at least a year.
In a statement, Bill Valle, CEO of Fresenius Medical Care North America, said the company is “committed to working to achieve the broader goals of expanding access to home dialysis, transplantation and new models of value based care for chronic kidney disease.”
Rachel Nell Meyer, director of policy and government affairs for the American Society of Nephrology, which represents more than 12,000 kidney health care providers, said that “by focusing on a more comprehensive approach to kidney health, the administration may actually improve care at every stage before kidney failure in ways the current system does not,” Meyer said.
Medicare spent about $35 billion on dialysis patients in 2016 — more than $89,000 per person, according to the kidney foundation. Transplant patients, in contrast, cost Medicare $35,000 per person.
Azar, whose father was on dialysis before he received a kidney transplant, also will develop ways to spur the development of an artificial kidney and to increase transplantation of organs.
A key to boosting transplantation will be cracking down on “organ procurement organizations,” the 58 nonprofit groups that collect organs from deceased donors and send them to transplant centers for implantation. Each OPO holds a monopoly over a chunk of U.S. territory and collects and reports its own data on how successful it is. Some poor performers have manipulated the numbers, researchers have shown.
New York’s OPO, for example, consistently has fallen short of government performance standards but has been able to block HHS efforts to shut it down because of unreliable data.
“I can’t think of anyone who would say our current measurement system is effective. It is not,” said said Kevin Myer, chief executive of the OPO in Houston.
Trump will order Azar to develop better ways of measuring OPO performance that are clearer, more reliable and easier to enforce, according to people familiar with the plan. On Tuesday, Sen. Todd Young, R-Ind., introduced legislation calling for similar measures.
“This is an unqualified win for patients,” Greg Segal, co-founder of ORGANize, a group seeking to improve organ transplantation, said in a statement.”OPO problems have been hiding in plain sight for years, but these government monopoly contractors have never received the sustained scrutiny they so desperately need.”
Trump also will instruct Azar to improve the process of matching kidney donors to recipients, as well as the speed of delivery, to reduce discards of usable organs.
Another Trump proposal would increase payments to live donors of kidneys and livers to cover more of their expenses, possibly including lost wages and child care.
“Anything we can do to make living donation easier for these altruistic people should happen,” said Jason Wellen, surgical director of kidney transplants at the Washington University School of Medicine. “These people give of their time, stay in hospitals away from their families and give away one of their organs.”