Home dialysis increased 180% in nine months for patients of a Roanoke, VA, nephrology group. But Valley Nephrology Associates said it took a robust educational effort and an all-hands-on-deck approach to convince patients to forego in-center dialysis treatment.

Jessica Saunders, Nurse Practitioner, Valley Nephrology

“The biggest barrier was resistance among patients who were already established within the in-center hemodialysis setting. The staff found it difficult to even talk to these patients,” said Valley Nephrology gerontological nurse practitioner Jessica Saunders, who shared her practice’s experience during a recent CMS Quality Conference webinar.

In 2019, Valley Nephrology Associates partnered with Fresenius Kidney Care Crystal Spring — part of Fresenius Medical Care North America (FMCNA) — on a quality assurance improvement project to identify barriers to home dialysis, which offers patients greater flexibility.

Saunders said familiarizing dialysis center patients with in-home technology, along with staff engagement, broke down barriers and increased the number of home dialysis patients from 10 to 28 during comparable time periods.

“All team members have to believe in home therapy and everyone has to buy in. That includes the nephrologists, the patient care technicians and other support staff, like dieticians and social workers,” explained Saunders. 

Forces of change

COVID-19 has made telehealth and in-home health services more attractive and accessible to consumers. But new payment models are also pushing these alternatives. 

On Jan. 1, the Centers for Medicare and Medicaid Services (CMS) launched the End Stage Renal Disease (ERSD) Treatment Choices (ETC) Model that will be mandatory for 30% of kidney care providers in all 50 states. The plan aims to encourage home dialysis and transplants in an effort to lower Medicare costs by about $23 million over five-plus years.

Chronic kidney disease (CKD) affects an estimated 37 million Americans — about 800,000 of them have ESRD, requiring dialysis. Those patients are some of the most costly to the Medicare system according to the Congressional Research Service. While they comprise only about 1% of Medicare beneficiaries, they account for about 7% of all Medicare spending.

In 2019, only about 13.4% of End Stage Renal Disease (ESRD) patients in the U.S. took advantage of home dialysis. But their numbers are increasing.

The U.S. dialysis services market is worth about $28 billion. Fresenius and DaVita Kidney are the biggest players, making up about 75% of the market, according to Morningstar Healthcare analyst Julie Utterback, who spoke to McKnight’s Home Care Daily. Last year, both companies said home dialysis comprised 14% of their dialysis business and is growing. 

Growth target

Fresenius has set a 15% target for home dialysis by next year. It merged with home dialysis equipment maker NxStage Medical in 2019. More recently, it increased its home support staff by 30% and is opening transitional care units to help patients learn how to dialyze at home.

Joe Turk, President of Fresenius Medical Care’s Home and Critical Care Therapies

“We are seeing that as many as 40 percent of patients who start in the transitional care unit will choose to go home. This is much higher than if a patient goes into an in-center dialysis unit without going through a transitional care program,” Joe Turk, president of Fresenius Medical Care’s Home and Critical Care Therapies told McKnight’s Home Care Daily.

New home dialysis firms are now entering the market, including Strive Health. The Denver, CO-based firm launched last April and is now serving 16,000 patients in five states.

Turk says the more competitors in the home dialysis space, the better. “The bigger the focus on home dialysis, the faster we are going to shift more people to see the benefits and grow the adoption of home treatment,” he said.