The Centers for Medicare and Medicaid Services (CMS) has recognized the need to ensure equal care for socially and economically disadvantaged chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients by proposed changes Current models that directly address health equity. However, CMS cannot act alone. While payers, health systems, and providers have a role to play in mitigating socioeconomic barriers to access and success in CKD care, the medical device industry also has a unique ability to build solutions that promote equity in care.
Human-centered design with usability and versatility in mind
There is a need for dialysis devices that are attractive to patients and suitable for use throughout the continuum of care. Medical device innovators and manufacturers must ensure that products are designed for use by all people in different settings, regardless of socioeconomic background, training or ability.
This means carefully considering the strengths and limitations of each care setting, including hospitals (intensive care and wards), dialysis clinics, long-term care facilities, or the patient’s own home. Furthermore, it should be considered in the light of the ongoing Covid-19 pandemic, which has had a devastating impact on this often frail patient population. If a patient involved in home hemodialysis (HHD) needs help and is unable to visit a hospital due to the pandemic, care teams need to ensure they can provide home help if necessary. The risk is particularly high for patients who rely on central hemodialysis (ICHD) due to frequent travel and close contact with other patients and providers, and caregivers need to be prepared to provide these services in a safe, compliant and efficient manner Patients provide services.
The role of the medical device industry in finding solutions to these challenges lies in its ability to create machines that can provide the level of care any patient needs, even in extenuating circumstances. Doing so requires manufacturers to consider power outages, non-traditional setups and even understaffing. It is also important for manufacturers to be aware of the challenges patients may face when using their products, including language barriers, learning styles and physical barriers.
All of these solutions rely on implementing an active (as opposed to passive) approach to care. To truly prepare for what the next wave of pandemics will bring, all patients need early CKD testing, including screening for underserved populations for CKD and advocating for access to affordable diagnosis and disease-modifying treatment. In fact, the greatest benefits of CKD care will come from early detection and treatment of people who do not have full access to primary care.
Advocate for improved reimbursement for home care
Many studies have shown that home HD is more effective than ICHD for patient quality of life and survival in some cases. This is because the increased frequency of treatments at home more closely reflects healthy kidney function. Needless to say, the longer the interval between treatments – as happens with ICHD over the weekend – the more suffering the patient suffers. However, home HD may not be readily available to all patient groups, especially those with lower incomes – home HD may increase the cost to the patient because of the increased electricity and water needed to run the dialysis machine. Additionally, patients may not have the space and infrastructure at home to conduct dialysis comfortably and safely. However, from a payer’s perspective, home HD has been proving to be less expensive, as less is spent on physical infrastructure, skilled healthcare personnel, and patient transportation.
In addition to more obvious solutions, including fighting for more patient-driven reimbursement and eliminating the red tape involved so HCPs can provide home care, medical device manufacturers must also offer turnkey solutions for home treatment, including door-to-door door pattern. Equally important, manufacturers must also recognize that not all patients have the reliable internet access required for successful home care. To easily integrate digital health features and analytics, device makers should consider relying on embedded connectivity to mobile providers, eliminating the need for patients to use their own WIFI or cellular data.
While CMS’ recent proposal is a foundational step toward providing more equitable access to CKD care, the agency’s success in promoting change is related to policy detail, implementation, patient-driven performance metrics, and through performance-based ESRD providers. Disclosure and financial responsibility are directly related to reimbursement. Achieving equitable access to CKD care is certainly a multifaceted challenge, but it is one worth addressing, and we have the tools to do so.
Photo: Edwin Tan, Getty Images
