Understand how we got here — and how to move forward.


March 8, 2019

1 in 5 Medicare dollars are spent on dialysis. Here's how Azar wants to change that.

Daily Briefing

    HHS Secretary Alex Azar on Monday said CMS' Center for Medicare and Medicaid Innovation is looking to change how Medicare pays for dialysis treatments and to increase the number of kidneys that are available for transplant.

    Here are 5 key tactics to attract and retain transplant patients

    Azar says Medicare's current policies for kidney care are 'failing'

    During a speech at the National Kidney Foundation's annual summit, Azar noted that more than one in five dollars Medicare spends goes toward kidney care, totaling about $113 billion in 2016. Azar attributed that high cost in part to existing policies.

    He explained, "Today, Medicare covers most patients with kidney failure. But we don't begin spending a great deal on these patients until they're already sick. It is the epitome of a system that pays for sickness rather than health, and [the Trump] administration is intent on shifting these priorities."

    In addition, Azar said, "In many ways, today's policies bias providers toward center-based dialysis" over kidney care alternatives, such as home-based dialysis.

    Further, Azar said dialysis centers currently have no incentive to help patients find or prepare for transplants, as such procedures could eliminate patients' need for dialysis care, and therefore mean dialysis centers could see fewer patients. He said HHS would like to encourage dialysis providers to help patients access transplants so they no longer need dialysis care. "We want to make the outcome that's good for the patient and good for the system good for their business, too," he said.

    CMMI working on new demonstrations for kidney care

    As such, Azar said CMS' Center for Medicare and Medicaid Innovation (CMMI) is working on new demonstrations for kidney care that would focus on:

    • Making more kidneys available for transplant;
    • Preventing, detecting, and slowing the progression of kidney disease; and
    • Providing kidney disease patients with more treatment options, including home-based care.

    According to Healthcare Dive, CMMI currently is considering new payment models for treating stage 4, stage 5, and end-stage renal disease.


    National Kidney Foundation CEO Kevin Longino praised Azar's focus on improving kidney care. He said HHS is "clearly charting a path towards making progress in prevention, early detection, treatment, research, and access to transplantation; all critical issues for kidney patients, and they are doing this in a strategic, thoughtful, and expedited way."

    Paul Conway, policy chair and immediate past president of the American Association of Kidney Patients (AAKP), said, "Azar has heard the frustrations and burdens of kidney patients, he understands kidney disease is both a health care and workforce issue, and he knows that informed patient choice, coupled with policy reform and better care options, will allow patients to gain greater control over their lives."

    Conway added that AAKP will work with HHS "to transform status quo kidney care into a value-based system defined by informed patient choice and treatments that empower, not impede, the inherent human aspirations to live, work and remain fully engaged in society" (Stein, Inside Health Policy, 3/4 [subscription required]; Pifer, Healthcare Dive, 3/4; Diamond, "Pulse," Politico, 3/4; Morrison, Washington Examiner, 3/4; Frieden, MedPage Today, 3/4; Clason, CQ Health, 3/4 [subscription required]).

    Here are 5 key tactics to attract and retain transplant patients

    Download this briefing to learn how to expand the pipeline of potential transplant patients and engage them across the care pathway.

    Download Now

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.