More than 90,000 Americans are waiting for a kidney transplant that could save their lives. Unfortunately, 12 of these people die every day while waiting for a transplant. The number of people needing a kidney transplant will continue to rise as more than 37 million people in the United States live with kidney disease – yet a staggering 90% don’t know they have it. While the overall number of organ transplant patients is growing, there are simply not enough organs to meet current or future needs. We have to find a better way.
While more can and should be done to increase the efficiency, effectiveness and equity of our nation’s kidney transplant system, we must recognize that our current health care system is falling short by not doing enough sooner, before people with kidney disease find themselves in crisis position, needing a new kidney.
We need to invest more time, effort and resources in preventive care to reduce the need for transplants in the first place. Early detection must be a priority so doctors can initiate therapies to slow progression. We need to have the mindset that we consider it a failure every time a patient with chronic kidney disease (CKD) progresses to the point where they need dialysis or a transplant. We will never be 100% successful, but we can do better.
The progression of CKD from stage 1 to stage 5 (kidney failure) can be delayed by treatment of other co-existing conditions, which sometimes directly affect disease progression. These include diseases such as cardiovascular disease, diabetes and high blood pressure. Simple steps also include quitting smoking and fighting obesity. When these concerns are better addressed in the early stages of the disease, the risk of hospitalization is also reduced, improving the patient journey while providing huge savings for patients and the healthcare system.
Kidney patients benefit from having access to a nephrologist. Regardless of whether the disease progresses early or late, the results are better. By detecting kidney disease early, patients have more time to work with their doctors to effectively treat their chronic kidney disease, thereby slowing the need for dialysis or transplant. Access to education empowers patients to make decisions that are appropriate for them. This is best accomplished when no one is in a rush, and not in a hospital after a patient has “crashed” into dialysis.
Our healthcare system must find ways to promote models of care that remove all barriers to accessing healthcare. The same models of care must promote communication between caregivers across all care sites. No more silos. Let’s eliminate the current fragmented system that focuses on volume rather than value. For far too long, nephrologists and nephrology practices have operated under a traditional fee-for-service model that pays based on the services they provide to a patient and rewards the level of care, but not necessarily the quality of that care. Give physicians space to address hurdles to treatment before a patient’s disease progresses. This will help reduce the burden on the transplant system and on the patients themselves.
If we want to reduce the need for kidney transplants, we must increase the adoption of value-based care (VBC) arrangements that align provider incentives with patient outcomes in a performance-based payment structure.
In VBC models, nephrologists are compensated for slowing the progression of kidney disease and providing 360-degree support to enable treatment of the whole person, not just one disease or collection of symptoms. VBC agreements empower and encourage providers to offer support and services such as care coordinators, nutritionists, behavioral health specialists and pharmacists, and to provide additional support such as transportation. The goal is to prevent hospitalizations by anticipating problems and then addressing them prospectively before a crisis occurs.
People don’t have to die waiting for a kidney. A VBC approach can quite logically and naturally lead to earlier detection of kidney disease and better treatment in its early stages. Private and public insurers, along with policymakers, must continue to explore and implement pay-for-performance models that can reduce the overall need and wait time for kidney transplants.
Photo: peterschreiber.media, Getty Images
Dr. George Hart brings a 30-year career in nephrology and as a practicing physician to his role as chief medical officer at Interwell Health, a kidney care management company that works with physicians to reshape kidney care. Previously, he was president of Metrolina Nephrology Associates in Charlotte, North Carolina, where he led an 80-provider practice while serving as medical director for Fresenius Kidney Care. Dr. Hart specializes in transplant nephrology and previously served as medical director for the kidney and pancreas transplant programs at Carolinas Healthcare System (now Atrium Health) and as a clinical assistant professor at UNC Chapel Hill. He earned his MD from Wake Forest University.