Current federal policies limit patient access to home dialysis, according to a report released today by economist Alex Brill of Matrix Global Advisors (MGA). As a result of policy barriers, Brill finds, a key segment of the growing population of patients who have End Stage Renal Disease  miss out on the important health and lifestyle benefits of home dialysis, according to the report. Brill, formerly chief economist to the House Ways & Means Committee, also finds that innovation in the home dialysis market may not reach patients if barriers cannot be addressed.

Read an interview with report author Alex Brill 

Fewer than 12% of patients with ESRD receive home dialysis today, though home dialysis offers patients important health benefits, and the ability to be more active and remain in, or re-enter, the workforce.

Read also: How to increase home dialysis use 

According to Brill, the barriers that preclude many patients from accessing home dialysis include the lack of sufficient provider education about home dialysis, insufficient reimbursement for home dialysis, limited patient awareness of the home modality, and potentially burdensome requirements for care partner support.  Most of these barriers were also noted in a report by the U.S. Government Accountability Office released November 2015.

Brill’s study recommends that policymakers alleviate these burdens by focusing on telehealth, reimbursement, patient education, and caregiver issues. He finds that both Congress and federal regulators can do more to help more patients receive the benefits of home dialysis by, among other things:

  • Better reimbursing the cost of home dialysis therapy;
  • Allowing physicians to leverage evolving telehealth and remote monitoring technology for their patients;
  • Funding more patient and physician education on home dialysis options, and
  • Clarifying and simplifying care partner requirements that may confuse patients or otherwise limit home dialysis utilization.

In 2015, the House introduced H.R. 2948, the Medicare Telehealth Parity Act, to make it easier for home dialysis patients to use telemedicine connections and remote patient monitoring to connect with their physicians.

Read also: Using a transitional start dialysis unit to improve modality selection 

“It is incumbent on policymakers to support policies to achieve greater access to home dialysis,” said Brill. “Not only could we see better health outcomes, but with greater uptake, the market can reach a tipping point toward accelerated growth, which can offer incentives for technological innovation that can further benefit patients.”

“Home dialysis can offer certain patients tremendous clinical and quality of life benefits,” said Dr. Rebecca Schmidt, Chief of the West Virginia University Section of Nephrology and President of the Renal Physicians Association.  “Patients deserve to have choices in their medical care and the option to dialyze at home, when safe and appropriate, is especially key in rural states like mine where many patients live distant to a dialysis center.  Home dialysis allows for greater independence and our patients have been able to continue or return to work because they feel better and are not tied to an in-center hemodialysis schedule.”