Rush Introduces Bipartisan Legislation to Expand Home Dialysis, Ensure Kidney Patients Are Educated About Full Range of Treatment Options
WASHINGTON — Today, U.S. Representatives Bobby L. Rush (D-Ill.) and Jason Smith (R-Mo.) introduced bipartisan legislation to expand access to home dialysis for kidney patients. Home dialysis often leads to better health outcomes and fewer hospitalizations for kidney patients; it is also far more flexible than in-center dialysis, making it easier for dialysis patients to maintain employment.
The Improving Access to Home Dialysis Act would provide Medicare reimbursement for trained, professional staff to visit home dialysis patients and assist them with their home dialysis treatments. The legislation would also ensure that all kidney patients are educated about home dialysis options early in their treatment process and given the support they need to utilize home dialysis should they choose to do so. And it would require the Department of Health and Human Services (HHS) to conduct a study on the racial disparities in the utilization of home dialysis and provide concrete data on outcomes for in-center and home dialysis patients. A 2016 study found that compared to white Americans, Black Americans were 60% less likely to be treated with home hemodialysis and 47% less likely to be treated with peritoneal dialysis at home.
“Home dialysis is a better treatment option than in-center dialysis for many kidney patients — it is far more flexible and can lead to better health outcomes and quality of life,” said Rep. Rush. “However, I am concerned by data showing that Black Americans are significantly less likely to be treated with home dialysis than their white counterparts. While I am grateful that my constituents are able to rely on dialysis centers in their time of need, I have long worried about the proliferation of dialysis centers in poorer and minority neighborhoods. We must do more to ensure that all kidney patients are able to access the full range of treatment options. The Improving Access to Home Dialysis Act will expand access to home dialysis and ensure that kidney patients are educated about the full range of treatment options available to them early on in their treatment process. Importantly, it will also track racial disparities in the utilization of home dialysis and patient quality of life. As a longtime champion for kidney health in Congress, I am proud to introduce this bipartisan legislation today and grateful for the support of the kidney community and my colleague Rep. Smith.”
More than 750,000 adults in the United States have irreversible kidney failure and require either a transplant or multiple dialysis treatments per week to survive. The vast majority (85%) of the 550,000 kidney patients receiving dialysis in the U.S. travel to dialysis centers for treatment, which takes place multiple times a week for up to four hours per session. This rigid schedule makes it difficult for kidney patients to hold down employment, and many face transportation barriers getting to and from dialysis centers. A recent study found that patients dialyzing in a facility were two to three times more likely to contract COVID-19 and the U.S. Renal Data System estimated that patients who received dialysis treatments in a facility were up to four times more likely to be hospitalized for COVID-19 than patients who dialyzed at home.
In September 2019, Rep. Rush led a letter to then-HHS Secretary Alex Azar and then-Centers for Medicare & Medicaid Services Administrator Seema Verma expressing concern over the rapid explosion of dialysis centers in poorer, largely minority, communities. A 2015 study by the Loyola University Health System found that the percentage of adults beginning dialysis for kidney failure between 1995 and 2010 rose 6.6 percentage points for adults in high-poverty zip codes compared to an increase of 1.5 percentage points for the general population.
Dialyzing at home means a patient can do more frequent but shorter dialysis sessions, which can lead to better health outcomes and fewer hospitalizations. Due to the increased flexibility of a home dialysis schedule, home dialysis patients are also more likely to maintain employment. Studies have also indicated that home dialysis could result in cost savings, as home dialysis patients have fewer complications and hospitalizations than in-center patients.
The Improving Access to Home Dialysis Act is widely supported by the kidney community, including the National Kidney Foundation, the American Society of Nephrology, and Home Dialyzors United (HDU). Here is what they had to say about the legislation:
"Home dialysis allows patients to decide when, how often, and for how long they dialyze. This not only gives them more time and energy to go to work and spend time with family, but also helps reduce patients’ risk of infection, hospitalization, and depression," said Kevin Longino, CEO of the National Kidney Foundation and a kidney transplant patient. “By providing patients with the support and training they need, this legislation will lead to better patient health outcomes, improved quality of life, and reduced risk for exposure to COVID-19. We sincerely thank the bipartisan Members of Congress who stood up for kidney patients and introduced this important legislation.”
“Home dialysis increases the survival, autonomy, and financial stability of the 800,000 Americans living with kidney failure and is especially important during the COVID-19 pandemic, which puts the health of people with kidney diseases at extreme risk,” said Susan Quaggin, President of the American Society of Nephrology. “However, only 12.5% of people undergoing dialysis do so at home, while Black Americans, Hispanic or Latinx Americans, and Asian Americans are between 7%-35% less likely than white Americans to receive home dialysis, a disparity due entirely to social determinates of health. The American Society of Nephrology commends Representative Rush and Representative Smith for introducing the improving Access to Home Dialysis Act which will address these social determinants and make home dialysis more accessible for all Americans.”
“The Advancing American Kidney Health Executive Order set a very high bar for kidney care, wanting 85% of new patients dialyzing at home or receiving a transplant by 2025. The Improving Access to Home Dialysis Act is critical to reaching that goal,” said Nieltje Gedney, Executive Director of Home Dialyzors United. “Patients dialyzing at home tend to be healthier, safer, and happier, but they must have an infrastructure they can rely on during training and in emergency situations. Staff assisted dialysis, in their own home, will be critical to keeping most dialzors at home long term. It can also benefit those requiring dialysis due to debilitating conditions that would otherwise necessitate skilled nursing in a facility by providing staff assisted dialysis to an incapacitated patient who can be surrounded by loved ones, instead of overworked staff. The Improving Access to Home Dialysis Act is a win-win for patients, families, clinicians, and insurers alike, by providing quality staff assisted home dialysis in lieu of higher cost institutional care.”
The full text of the Improving Access to Home Dialysis Act of 2021 is HERE.
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