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Dan Mendelson Commentary on Health Equity Featured in Forbes

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The COVID-19 pandemic and a summer of focus on racial justice has finally begun to intensify government interest in reducing racial disparities in healthcare. Understanding that healthcare providers and systems tend to respond to the economic incentives that are presented to them, current government decisions on payment options around renal dialysis present an important test case for the Trump Administration.
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Dialysis Care is Evolving

In the summer of 2019, the administration made clear its intention to deliver “bold change” and disrupt the current kidney care paradigm in the United States by signing the Advancing American Kidney Health executive order. This initiative seeks to improve the prevention of and treatment options for kidney disease, which is particularly relevant given over 35 million American adults are estimated to have some form of impairment to kidney function.

Of this population, an estimated 750,000 Americans suffer from total kidney failure—known as end-stage renal disease (ESRD)—and require either regular dialysis treatment to remove waste from their blood or a kidney transplant to survive. This subset of patients with ESRD present an interesting and important case study to examine how the government’s payment policies can unintentionally create incentives for inconsistent or inadequate patient care.

The ESRD population is unique in that Medicare coverage is conveyed by virtue of kidney failure; this creates a dynamic where a vast majority of patients are covered (and providers paid) by one government program: Medicare. The government has provided coverage to these individuals since the 1970s largely due to the fact that the treatment required to keep patients alive can be profoundly life-altering.  Almost 90% of all dialysis patients receive multiple-hour treatment in a facility 3 times per week.

These patients are also unique compared to the broader Medicare patient population due to their demographics and their associated costs of care. Dialysis patients tend to be younger, less white, and more concentrated in urban areas than the broader Medicare population. Importantly, while ESRD patients represent less than 1% of the traditional Medicare population, their care accounts for about 7% of total Medicare expenditures.

Read the full Forbes piece.

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