CMS has proposed a target of 80% of dialysis receiving home dialysis. Yet less than 14 percent are treated by home dialysis. We have known for years that home dialysis is safer, cost less and more convenient than center and hospital hemodialysis. Often, referral to home dialysis from hemodialysis occurs when there are issues with vascular access, often in older and more frail patients.
In addition to policies, contracts that set target home dialysis, patient training and shared decision support for the initial decision of dialysis can increase rates for home dialysis, producing lower costs and better outcomes. End stage renal disease is a global issue. Many countries are working toward higher rates of home dialysis.
Contracting for better outcomes and lower costs related to the types, the location and frequency of dialysis should be every commercial, state and federal contract. And do get me started on how poorly we prevent and treat those at risk for end stage renal disease in the US.
References
US Department of Health and Human Services, Centers for Medicare & Medicaid Services Medicare program; specialty care models to improve quality of care and reduce expenditures. https://www.hhs.gov/sites/default/files/CMS-5527-P.pdf
Liu FX, Walton SM, Leipold R, Isbell D, Golper TA. Financial implications to Medicare from changing the dialysis modality mix under the bundled prospective payment system. Perit Dial Int. 2014 Nov-Dec;34(7):749-57
Oliver MJ, Salenger P. Making assisted peritoneal dialysis a reality in the United States: a Canadian and American viewpoint [published online ahead of print December 18, 2019]. Clin J Am Soc Nephrol. 10.2215/CJN.11800919.
Lobbedez T, Verger C, Ryckelynck JP, Fabre E, Evans D. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin J Am Soc Nephrol. 2012 Apr;7(4):612-8
Greenberg KI, Jaar BG. Urgent start peritoneal dialysis: are we there yet? BMC Nephrol. 2020 Jan 31;21(1):39
Koc Y, Unsal A, Basturk T, Sakaci T, Ahbap-Dal E, Sinangil-Arar A, Kose-Budak S, Kayabasi H. Is there impact of mortality prior hemodialysis therapy in peritoneal dialysis patients? Nefrologia. 2012 May 14;32(3):335-42
Dialysis Market Size, Share & Industry Analysis, By Type (Products and Services), By Dialysis Type (Hemodialysis and Peritoneal Dialysis), By End User (Dialysis Centers & Hospitals and Home Care), and Regional Forecast, 2025-2032, Fortune, June 16, 2025, https://www.fortunebusinessinsights.com/dialysis-market-102367
Home Dialysis: Safer, Convenient and Less costly
CMS has proposed a target of 80% of dialysis receiving home dialysis. Yet less than 14 percent are treated by home dialysis. We have known for years that home dialysis is safer, cost less and more convenient than center and hospital hemodialysis. Often, referral to home dialysis from hemodialysis occurs when there are issues with vascular access, often in older and more frail patients.
In addition to policies, contracts that set target home dialysis, patient training and shared decision support for the initial decision of dialysis can increase rates for home dialysis, producing lower costs and better outcomes. End stage renal disease is a global issue. Many countries are working toward higher rates of home dialysis.
Contracting for better outcomes and lower costs related to the types, the location and frequency of dialysis should be every commercial, state and federal contract. And do get me started on how poorly we prevent and treat those at risk for end stage renal disease in the US.
References
US Department of Health and Human Services, Centers for Medicare & Medicaid Services Medicare program; specialty care models to improve quality of care and reduce expenditures. https://www.hhs.gov/sites/default/files/CMS-5527-P.pdf
Liu FX, Walton SM, Leipold R, Isbell D, Golper TA. Financial implications to Medicare from changing the dialysis modality mix under the bundled prospective payment system. Perit Dial Int. 2014 Nov-Dec;34(7):749-57
Oliver MJ, Salenger P. Making assisted peritoneal dialysis a reality in the United States: a Canadian and American viewpoint [published online ahead of print December 18, 2019]. Clin J Am Soc Nephrol. 10.2215/CJN.11800919.
Lobbedez T, Verger C, Ryckelynck JP, Fabre E, Evans D. Is assisted peritoneal dialysis associated with technique survival when competing events are considered? Clin J Am Soc Nephrol. 2012 Apr;7(4):612-8
Greenberg KI, Jaar BG. Urgent start peritoneal dialysis: are we there yet? BMC Nephrol. 2020 Jan 31;21(1):39
Koc Y, Unsal A, Basturk T, Sakaci T, Ahbap-Dal E, Sinangil-Arar A, Kose-Budak S, Kayabasi H. Is there impact of mortality prior hemodialysis therapy in peritoneal dialysis patients? Nefrologia. 2012 May 14;32(3):335-42
Dialysis Market Size, Share & Industry Analysis, By Type (Products and Services), By Dialysis Type (Hemodialysis and Peritoneal Dialysis), By End User (Dialysis Centers & Hospitals and Home Care), and Regional Forecast, 2025-2032, Fortune, June 16, 2025, https://www.fortunebusinessinsights.com/dialysis-market-102367