In a twist, a major of aspect of their initiative would rely on an innovation center created under the Affordable Care Act, which President Trump has vehemently opposed. The proposal would create pilot programs to test alternate ways of reimbursing physicians to encourage treatment of kidney disease earlier and potentially avoid the need for dialysis.
“It is the needed paradigm shift for the United States,” Dr. Brigitte Schiller, the chief medical officer for Satellite Healthcare, a nonprofit chain of dialysis centers, said in an interview before the announcement. The current system “makes it very easy to send a patient to the centers.”
In the United States, the rates of kidney transplants and in-home dialysis have lagged those in other developed countries, a situation that many say can be blamed on a host of financial incentives that discourage better options.
Companies that operate clinics, such as DaVita and Fresenius, profit from recurring visits by patients coming to their centers. In addition, many kidney specialists, or nephrologists, have a financial interest in dialysis centers in their communities, either by serving as the clinics’ medical directors or owning a stake through a joint venture with a dialysis operator.
“One of the fundamental challenges is the fact that physicians don’t make their money treating kidney disease; they make money on dialysis,” Arvind Rajan, a co-founder and chief executive of Cricket Health, a San Francisco start-up that is focusing on kidney care, said before the announcement.
Changing the incentives “is sorely necessary,” added Mr. Rajan, who said private insurers that are paying for kidney care have already begun trying to shift more people to home or to consider transplants. “The landscape has changed really quickly,” he said.
Although the big chains have also begun selling in-home dialysis services, they have invested heavily in their brick-and-mortar centers, Dr. Graham Abra, a specialist at Stanford University, said before the president’s speech. “There’s an incentive if you build a center to fill it, and push that,” he said.